Thanks for stopping by to what, I hope, will be more than just a public-facing bit of whinging. This week is Men’s Health Week and we are remis if we exclude mental health from that conversation. However, as this blog will be talking about both personal and larger societal issues surrounding mental health, I’d like to make the acknowledgment up front that these are challenging issues. They are as hard to hear about as they are to talk about. So, if you are someone who is potentially affected by mention of suicide and mental illness in general, it might be best to skip this for the time being. Go take the time you would have spent reading this and do something nice for yourself instead. It’s been a rough year and however many months, you deserve that. For those that stick around, this blog will invoke a good deal of personal experiences along with larger discussions of men’s mental health and the issues around seeking support, but I’d urge you to not be discouraged by my own journey and do what you can to progress your own. However, I hope it does have some useful insights and you take something away from it. I am also unfamiliar with research being done for those on other parts of the gender spectrum and their mental health, so this will be about cis men and women. I assume much of it applies to people generally, but I also don’t want to speak to what I don’t know. Now, onto the main attraction.
So, first thing’s first, a bit about me. As of writing this, I am a 28 year old, cis, heterosexual, white man from the U.S., Chicago specifically. I do recommend a visit, the lakefront is beautiful, the food is amazing (yes, even Chicago-style pizza, you nay-sayers), and the people are lovely. I left my native Chicago for Aberdeen about 21 months ago for my PhD. I grew up around Chicago, lower-middle class family, but never wanted for much except all the video game systems my friends had. That’s just to say that I didn’t feel I had much to complain about. I was a bit of a lonely kid, but I often liked it that way. It wasn’t until I was about 13 or so that I realised, hey I could probably due with some friends, maybe even a girlfriend. A little ambitious, in hindsight, but you dream big when you’re young. It was during that time that I first started to feel like something was amiss in the way that I understood and interacted with the world and the people in it. I couldn’t quite keep up with how the other kids around me got on with one another, how they formed and maintained friendships and relationships, and how easy it seemed for them. I was 15 when I first engaged with someone that wasn’t my mother about how all that made me feel. She was the school’s counsellor, one woman tasked with the mental health of around 1200 students. And yet, this woman let me knock on her door whenever I was feeling upset or confused about navigating my teenage years. She listened and hugged me through my tears and reassured me that, wherever I might go, there was always going to be someone willing to listen.
I made it through school and into university. I had sense enough to know that I was going to need someone else to listen because moving to the big city at 17, not knowing anyone, having to captain my own ship, that wasn’t going to be an easy experience. And how right I was, unfortunately, but the university did offer a counselling service. They only allowed short-term care but it was something and, importantly, free. And so begun a tenuous relationship with psychotherapists and counsellors that has lasted nearly a decade. The case in the US, as it is here in the UK, is a mental health system that does not effectively meet the needs of the population, for reasons that are too numerous and in-depth to get into here. Suffice to say, battling with insurance companies, changing policy, scheduling issues, and the very real cost of paying to talk to someone when their fee was your week’s grocery budget, led to just as much distress as I was hoping to ameliorate. I was able to find some amazing listeners, people that made me share and reflect on who I am in ways that challenged me to be better whilst advocating for my worth as an individual. On the other end of the spectrum, I met “mental health professionals” who would be more at home as the heartless bureaucrats in a dystopian sci-fi novel. These individuals met my struggling with such indifference or outright contempt that I worried I had somehow walked into the wrong office. As someone trained in psychology, and with both the academic and personal perspective of just what mental illness was, I am still appalled to this day that these individuals chose a profession with which they were ostensibly incompatible. To say that interactions with these individuals left me with a reluctance to reengage with mental health professionals, perhaps, doesn’t need explanation. But the fact that I still needed help didn’t change.
It wasn’t until I was 24 that I decided to try medication. I’d always been afraid of it. I was afraid of side-effects, sure, I knew them too intimately from having to memorise classes of psychopharmaceuticals. What I was most afraid of, though, was the sense of unknown that I felt lurking at the bottom of a pill bottle. I knew who I was and I knew my demons. Did I know how to fight them? Well, no, obviously, but there is something comforting about dealing with a known enemy. There was a fear that who I was, my sense of self, was so inextricably tied up in the illness that I was experiencing that I wasn’t entirely sure there would be anything left if that was torn away. How was I going to be a good poet if I didn’t suffer from deep but inspirational bouts of melancholy (spoiler: it’s hard to do much of anything, much less anything creative, when you can barely feed yourself)? So, I met with one psychiatrist, then another, then another. All in all, I tried four different medications for depression and anxiety, along with others for sleep, nausea, and the like. Unfortunately, none of those four worked and it definitely was not fun. Medications are a blessing for many people but for me it was just a frustrating cycle of trial and error without any clear benefits.
So where am I now? Well thinking back on many of the issues that I’ve brought up to therapists and psychiatrists, I think I’m in a better place. When I came to Aberdeen, I once again tried to engage with a therapist, tried a new medication, tried to find help. A PhD is an entirely different beast from the academia I’d engaged in thus far. Namely, it is your project and you are responsible for it, from start to finish, and that is daunting. I’ve never been known for my time management skills - I’m a chronic procrastinator - but up until this point, that’s always worked out in the end. But now, I’m essentially in charge, the deadlines are mine to set. And let me tell you, I am a pushover of a line manager. When the structure fell away, I could feel the pressure mounting, but I hoped that I could adapt. Then the pandemic came knocking and it knocked away any semblance of routine and structure that I had managed to piece together. Things started to get bad in a way that I was not ready for and I didn’t know where to turn. The GP that was treating me left without so much as a letter. The psychiatric services I hoped to be referred to turned me away. They said I wasn’t sick enough, clearly, since I was so high achieving, a PhD student and all. They made that decision from one 5-minute chat, one communicated to them second-hand by a GP. And then, that was it. My GP couldn’t make any “official recommendations” but said I could always have a look around for private care. I won’t have to go into much detail for those that have tried to access any private care, but for those who haven’t, it is expensive. For a student, it might be wholly unreasonable. For me, I had no other choice. If I wasn’t able to do my work, I’d soon lose my place. If I lost my place, I’d lose my new home in Scotland and have to return to a country losing upwards of 50,000 lives a month due to Covid. During this whole time, I was racking my brain over why I could not bring myself to work, why I could not bring myself to do the things that others seemed to do without issue. Why did I lose interests in hobbies so quickly? Why did I have libraries of partially read books and un-played video games? Why did I have such a hard time keeping in touch with friends? Why did the entire world seem too loud and yet the silences deafening? At some point during all this, something came across my usual idle internet scrolling that gave me pause.
What I saw was a series of screenshots from a documentary called “ADHD: Not Just For Kids”. In them, I saw a man describing what mirrored my own past in some important ways:
“Classic case of Attention [Hyperactivity] Deficit Disorder is the 19 year old female university student. They go off to university and everything starts to fall apart. It doesn’t fall apart because they’re partying too much or they’re not mature enough […] It’s because for the first time in their life that exoskeleton wasn’t there. Then things don’t go well and then they’re left with this feeling of ‘I’m not as good as everybody else, I’m not as smart as everybody else.’ [They] show up at the university health services and the psychiatrist says, ‘well how long have you been depressed for?’ And the psychiatrist has slid the young lady into the psychiatrists comfort zone of depression and anxiety.”
Within a day or so, my girlfriend shared some other personal accounts of people suffering from undiagnosed ADHD and asked if I had considered I might be one of them. That was enough to get my attention which, it should be clear now, is hard to do. Within a week, I had an appointment with a psychiatrist who specialised in ADHD. Within that forty minute conversation, I had a diagnosis and a plan. Within six months of starting a new medication, I had hope that I could finish my PhD. Within those six months, I have been able to start planning past the immediate future, of the “now or not now” myopia that my mind could not see past. The despair I felt from not being able to get myself to do things has been receding. The anxiety of knowing deadlines are encroaching relentlessly without being able to do anything is slowly being replaced by the ability to work on things incrementally. The medication hasn’t been the magic wand that’s made nearly three decades of neurobiological and psychosocial deficits disappear overnight. But through all the effort, time, and money I have spent in the past decade to find answers, it is at least the first time I’ve been able to catch my breath.
There’s a great deal more I can say about my own mental health journey but I want to hit on a few key points. As alluded to in the quote above, ADHD is probably being un/misdiagnosed quite often, especially in girls and women, but also in adult men and others. Part of this appears to be stigma around the diagnosis and that most people would assume it’s something that only children, especially boys, would be diagnosed with. Another large contribution, which is also alluded to in that above quote, is that so few people are comfortable making these diagnoses. Many GPs, and even psychiatrists, don’t seem to be getting the adequate training to even recognise symptoms well enough to know that they need to then refer to someone who is a specialist. A friend who has gone through a similar process of adult ADHD diagnosis has told me that there is one specialist, a singular person, who is able to provide them care in a major European capital. This is astoundingly disappointing and is no doubt compounded with the larger issues faced by so many in getting referred to or engaging in mental health services. I was able to go private, as was this friend, at a significant personal cost to both of us as students. This cost is a substantial socioeconomic barrier and a commodification of our mental health. No conversation about health, but mental health in particular, can be divested from the socioeconomic realities that we are all facing. Sociologist Amy Chandler at the University of Edinburgh summarises this in the discussion of one of her studies,
“Finally, talking about problems or emotions does not change the structural, economic, or political conditions which may shape men’s distress. Most participants in this study were out of work and receiving benefits. Lack of work, or inability to work, and the shaming of benefits claimants in 21st century austerity Britain shapes and produces distress. Talking and having some social support may help individuals to feel better, but as noted knowingly by several participants, it does not significantly change their housing situation, money worries, or employment status; and it does not generate valuable jobs that can be undertaken by men who have worked in manual labour all their lives but are now physically disabled. As Tyler and Slater (2018) argue, campaigns which focus on ‘talking’ or ‘tackling stigma’ in response to mental health are deeply entangled with the interests of neoliberal capitalism, in diverting attention from the social and economic conditions which produce and maintain distress. (2021)”
Chandler’s work also delves into the disheartening discrepancies in the number of men who die by suicide compared to women. This issue is the subject of a good deal of policy debate and research looking into why men are dying so disproportionately. Much of the work, at least that I’ve seen, points to cultural issues in the ways men and women are taught to display and process emotions (I haven’t seen much on others within the gender spectrum, unfortunately). These gendered stereotypes have myriad negative consequences, with one being that men feel stigmatised against seeking support when they are experiencing mental health issues. The response to those consequences has been to advocate for the reduction in stigma towards men seeking help, notably in public health campaigns encouraging men to “speak up”. Now, I think that this conversation is certainly worth having. The gendering of how we’re all meant to experience and share our emotions is pure nonsense. It does make men embarrassed to speak up for themselves, so that they don’t seem “weak” or “feminine”. Seeing our fathers internalise their stress until it has metastasized into the white-hot rage that sends a wine bottle whizzing by your head is the very real consequence of men not having the space to be emotionally-whole people. And, conversely, women being seen as naturally able to do so diminishes their struggles and can lead to them being minimised when they do seek help.
However, I do not think it is near enough to make a meaningful impact in the numbers of people that we are losing to suicide. As Chandler points out, a television advert with a professional actor expounding the virtues of seeking help is incredibly tone-deaf when that care is outside the means of so many. When money and resources are put into developing public health campaigns but the very services they advocate for are underfunded and inaccessible to many, it doesn’t lead more men to talk but compounds their frustration. And as Chandler points out, if these men are stigmatised for seeking benefits, if their livelihoods are at risk because of poor economic policies, if their physical health has failed them and they’re unable to find timely care or meaningful work, those things are going to drive men further into the depths of mental anguish. And what is true for men is true for other people, of course, but men are also dealing with the gendered pressures of being providers to their families. When the same society that tells you to find meaning through your work and your ability to provide then turns a blind eye when you break your back at your second job, it’s certainly enough to drive you mad.
Now, again, I want to make it clear that men, and everyone, should feel able to express ourselves in healthy ways. But I do feel that a good deal of the conversation is, perhaps unduly, focused on “speaking up”, for the reasons I’ve mentioned. However, I am the first to advocate to friends and family about talking to a professional when things have reached a certain peak. And I want to tell you the same, if you’re reading this and feel it could do you some good, then you should try. Luckily, there are resources out there. For instance, the British Association of Counselling and Therapy has a search function where you can find therapists according to your needs (https://www.bacp.co.uk/about-therapy/telephone-and-online-counselling/). Many of them offer a free initial session which will allow you to get a sense if you’ll be able to benefit from a relationship with that counsellor. You can think of it like a job interview. You should feel free to ask them questions about their experience, have they had people with the same sorts of issues that you’re having, what drew them to be a therapist, things like that. With therapy, I’m of the opinion that it is just as much, if not more, about the trust and comfortability that you have with the therapist as it is about their qualifications. Check those too, obviously, Google is your friend. But you should feel like you’re talking to someone that does legitimately care about you and what you’re going through. I also want you to know that it’s okay if you don’t feel ready to talk. I’ve been in and out of therapy for a third of my life but I still struggle to open up sometimes. There are other ways to pursue mental health and emotional well-being. My personal views are that meaningful relationships with friends, family, and partners contribute to feeling well. And it is not about the quantity of these relationships but the quality. Knowing that you have the support of someone, even if you can’t or don’t want to talk about your feelings all of the time, is really important. The right people will let you be you on your own terms. A sense of community is also important, I believe, to feeling okay. That can come from hobbies, like video games, cinema, gardening, sport. If you like doing it, chances are there are others that want to do it with you or, at least, engage with you about it. Take care of things, like plants or pets, so that you can feel connected to the world around you. I think it also reminds you how to take care of yourself. When you are taking care of yourself, avoid absolutes. Brushing your teeth for 30 seconds is better than not doing it at all. A walk around your neighbourhood might not be a 5k but at least you’re outside and moving. Do what you can when you can.
This long-winded rant about my own mental health and the failings of the current system might not have been the most uplifting read. However, I hope that it has offered an honest insight into my journey that can be of some use to yours. I think these kinds of conversations should be franker and more casual so that we don’t have to feel as if we’re taking up too much space or are otherwise “not allowed” to talk, whatever the reason. Be proud of yourself for sticking with it, it is not an easy thing to do. How you’re feeling is not your fault and it has so much to do with how humanity (certain parts of it anyway) has decided to place production over people. You owe them nothing. You owe yourself kindness.
If you, or someone you know, is in need of help at Aberdeen, you can find information on the University’s counselling service by clicking here. The University has also partnered with Spectrum.Life to provide free and immediate emotional support, along with other life advice, through a helpline phone number or instant messaging when University services are unavailable. You can reach them by dialling 0808 196 2707 in the UK or 00353 1518 0277 if you are overseas, messaging on WhatsApp - just text "Hi" to 00353 87 369 0010 or online just click here.
I hope you are able to have a lovely summer and enjoy a bit of sunshine.