A recent survey found that men feel much more comfortable talking about their physical health than their mental health. This survey overlaps with other research indicating that men are much less likely to use mental health services than women.
Why is it that many men tend not to talk about their mental health? One popular explanation is that men are stubbornly silent due to a self-defeating “toxic masculinity” and that men need to overcome their internalized “masculine norms” to better initiate mental health discussion.
This view has been implicitly adopted by many prominent mental health organizations, social media users, and high-profile individuals. For example, Prince William recently stated that we must “pass the message onto men everywhere that it’s OK to talk about mental health.” Likewise, popular Twitter hashtags on men’s mental health include #itsokaytotalk.
However, a systematic analysis of the research literature indicates that this monocausal explanation is a very simplistic rendering of a complex situation. As outlined in my recent book Men’s Issues and Men’s Mental Health (Springer 2021), there are many practical, financial, and personal reasons why some men do not talk about their mental health.
Just who is listening?
There is an assumption that there is a reservoir of competent and helpful people willing and able to empathically listen to men with mental health issues. However, the scientific evidence indicates that this is not necessarily the case. In my own research studies, I have regularly heard men state that they have tried to talk about their mental health but have been shut down. Here are a few emblematic examples.
- A divorced middle-aged gentleman told me that he phoned his only sibling during an incipient mental health crisis but was asked to call back in a few hours as the sibling was watching a movie. When he called back, the call went to voicemail.
- An immigrant father was struggling with mental issues that affected his ability to work and provide for his family. When he tried to discuss his issues with his wife, she would scold him by stating, “Are you a husband?” or “are you a man?”
- A male student noted that he has tried to talk about his mental health issues with various peers but found that they quickly zoned out and reached for their cellphones. He gained a reputation as a “whiner” and lost friends as a consequence.
In short, research indicates that many men with mental health issues have tried to reach out and talk about their problems but have commonly found an unresponsive or indifferent audience among their entourage. This obviously deters any future efforts to discuss mental health.
Instead of talking to people in their social network, men with mental health issues also have the option to seek out and consult trained therapists and other mental health clinicians. However, there are many unacknowledged and oft-ignored barriers to such action, often revolving around employment.
Of note, men still remain the primary breadwinner in a typical family, and their income is essential for food, shelter, and quality of life. This means men tend to work longer hours than women and are constantly striving to impress their employer with a view to pay raises, promotions, and job security. As such, many men are averse to taking time off work for health reasons to avoid perceptions that they are unreliable employees.
This is especially true if the employee wishes to take time off to see a mental health professional. Some research indicates that certain employers equate mental illness with malingering, hypochondria, and laziness. Moreover, men with mental health issues may be stereotyped as dangerous, unpredictable, and a threat to workplace morale in male-dominated workplaces that put a premium on safety issues such as the police, military, transport, and oil and gas.
Indeed, a recent survey of workers found that around 1 in 4 workers believed their job could be at risk if they talked about mental health issues at work, around 1 in 3 believed they would be overlooked for promotion if they mentioned a mental health problem, and just under half believed it would lead to negative comments from workplace colleagues. Again, this acts as a massive deterrent to talking about mental health in men.
The costs of talking
In other words, some men in mental distress may have legitimate fears that the disclosure of mental health issues will damage their employment status, future job opportunities, and interpersonal relationships.
As such, some men may make a calculated cost-benefit analysis, weighing up the socio-occupational costs of disclosure with the potential mental health benefits. For some men, any disclosure will be deemed to bring more costs than benefits, especially if the labor market indicates they are easily replaceable, meaning they will continue to struggle in silence so that they can maintain their employment and income.
These processes have been overlooked in much of the popular discussion about men’s mental health, which has instead taken an essentially flawed, monocausal approach by focusing on the alleged negative impact of toxic masculinity and masculine norms.
Some men are fortunate to have supportive family, friends, employers, and colleagues. But the sad reality is that many men face indifference, reproach, and other negative repercussions if they make efforts to talk about their mental health. In many social contexts, men learn that it is not really OK to talk about their mental health, despite the well-meaning remarks of Prince William and assorted Twitter users.
As such, it is wrong to blame or target men for their alleged silence or reticence to discuss mental health issues. Instead, there needs to be a much greater focus on social context, including:
- Mental health literacy programs in schools, workplaces, and elsewhere to improve public understanding of mental health
- Occupational health reform to ensure that mental and physical health issues are treated equally in workplaces
- Better provision of evidence-supported, male-sensitive mental health services, such as peer support programs for men (detailed in a previous blog post here)
Trite clichés do not help anyone talk about their mental health. Instead, a context-aware, multi-pronged approach may be the best way forward.