INTRODUCTION

It always seems impossible until it’s done.

Nelson Mandela

Whoever you are and whatever reasons you may have, it’s great that you are seeking information or help through this book. In terms of mental health, men are affected by everyday stress, high workloads, anxiety and depression, loss of confidence or identity, relationship breakdown, family disruption, addictions and trauma to name a few. And men have found it hard to seek help in the past because of a sense of shame that, in fact, stems from the society we live in. We know that too many men are suffering in silence, and male suicide rates are very high. If you watch the media, you will regularly hear the current worrying statistics about men and mental health issues.

Written for men of all ages, The Changing Man provides a collection of tried and tested tools to tackle mental health issues. The book aims to help men become as resilient as possible in life, to prevent issues from arising in the first instance, or stopping them from recurring. There are not a huge number of resources available for men, and the majority seem to be on building muscles and not much else! This is an indication of the sort of messages society gives about what it is to be a man. However, men deserve more than this and need more than this.

Thankfully, times and men are changing! They are redefining what it is to be a man and reaching out for information about themselves and the life issues they are experiencing. Not too long ago, I took an Uber to go to an event. The first driver, who was 37 years of age, told me that he and his wife were thinking about having a family, but he wasn’t confident about being a father. We talked through his concerns. The driver on the way home was 23 years of age. He was working two jobs and saving up for some things he wanted in life. He asked, ‘Do you have any wisdom to share on life?’ I suppose my silver-grey hair has an air of knowing about it, so I shared some thoughts with him about focusing on what is important to him in life and making sure to live in the moment as much as possible!

These young drivers were wanting to talk about life and searching for some answers. If you are reading this book, no doubt this applies to you as well. In the past few years, more and more men have booked in to my practice for some assistance. They have been looking for answers as to why they are struggling with their emotions or problems in life, and they have been open to learning about ways to improve how they are feeling and functioning, and seeking change.

Over my 30 years as a medical practitioner, I have studied, practised and taught in the fields of medicine, mental health and therapy, both in Australia and overseas, and have been recognized with various awards. I have done a great deal of work with people in the armed forces, the majority of whom have been male. I have seen many who have viewed being a man and a serving member as needing to be incredibly strong, and many who have been affected by significant trauma from their time in service. However, emerging from their suffering has been a new definition of ‘courage’ — being aware of the issues, seeking assistance with their mental health and dealing with the issues and the related emotions.

In addition, I have a vested interest in men’s wellbeing. On a personal level, I was very close to my father, and I was very involved in his care in the years before his death. I am also very fortunate to have a son, Alex, who I have learnt a lot from by raising him with his father. And I have a male partner in life.

The Changing Man has been a joint project for Alex and me. Alex is a professional musician and very creative. He is also very interested in men’s mental health. This has stemmed from undertaking some studies in psychology and having an empathetic nature. Alex has supported friends with mental health issues, and we have both had to tackle anxiety in one form or another in our personal lives.

Alex has helped to research this book due to this interest, and he has contributed significantly to the writing. In particular, he has brought a young man’s perspective to the content, and you will find that he has given his voice to a series of tips, which you will see throughout the chapters.

The aim of a doctor or therapist is to provide a safe place for people to talk, explore and to learn some helpful techniques. Hopefully you will see this book as a safe place too. It is written as though we are simply talking — sometimes questions are posed to you, and possible answers are offered. I say ‘possible’ because no one has all the answers, and everyone’s situation is different. Remember that you are the expert on yourself, and this book aims to add to your existing knowledge.

Although the focus of this book is on mental health and wellbeing, you will find that some information on physical wellbeing is also included. This is because both physical and mental health are important and they impact each other.Interestingly, people seem to more easily recognize the need to look after their physical fitness, and the value of working on one’s mental fitness is not as well recognized. Consider that the contents of this book can give you many good ideas for regular mental health ‘workouts’, to improve your sense of wellbeing.

Working on and improving your mental health involves practice and change but, as we all know, change is hard. Key points and lists have been included in the book, so it is easier to access the information. We have also adopted the idea of a ‘toolkit’, with a range of tips and tools listed to help you manage life’s ups and downs. This allows you to read the book from start to finish or you can dip into it whenever and wherever you choose. The different types of tools in the book address various issues including stress and anxiety, unhelpful thinking habits or behaviours in life, managing uncomfortable emotions, coping in times of change or challenge, preventing relapses, and improving your general wellbeing.

In terms of the different psychological approaches and tools outlined in this book, remember that ‘no one size fits all’. The intention is to lay them out in front of you so that you can explore them all and decide which ones fit best for you. You can then choose which ones to put into your toolkit, so they are ready to pull out and put into action as you need to.

We cannot cover all the issues related to men’s mental health in this manual, but we have picked out some of the main ones, and many resources are provided at the end of the book. We have endeavoured to find reputable and useful resources originating from a range of countries to suit readers everywhere. Sometimes this has been challenging for a particular topic, but we hope that you can benefit from the resources we have managed to locate. We have favoured quality over quantity.

We live in a constantly changing world which at times is very stressful. Mental health issues are increasingly common, and they can affect our lives significantly or cause loss of life. There are still many barriers to overcome in relation to society’s messages about what it is to be male, and about seeking help when there is distress. Fortunately, we are starting to tackle these barriers and remove them. The Changing Man is part of these endeavours, so let’s get on with it!

1.

ABOUT MEN’S MENTAL HEALTH

If you can change your mind, you can change your life.

William James

Having some knowledge about men’s mental health gives you a greater understanding of some of its challenges and may help to empower you to possibly go a bit easier on yourself and to take some action towards change.

The key to understanding men’s mental health is exploring the meaning of ‘masculinity’ or what it is to be a man. Equally, we need to consider the negative impact of shame in men’s lives, because overcoming shame is one of the most important areas in men’s mental health.

In this chapter, we will look at the issues affecting men’s mental health, and in the chapters that follow we will build on this information with many practical ideas and tools.

WHAT’S THE STORY WITH MENTAL HEALTH?

We often take our health for granted, but it is central to feeling good about ourselves, both physically and mentally. When you have the flu or a painful injury, you realize how important your physical health is. Equally, when you feel emotionally exhausted or down, you realize how important your mental health is to your sense of wellbeing.

According to the World Health Organization (2014): ‘mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.’¹ It involves our emotions (feelings), thoughts and behaviours (actions). The Oxford Dictionary defines wellbeing as a state of being ‘comfortable, healthy or happy’. So, who doesn’t want more wellbeing?

Psychologist Abraham Maslow talked about a ‘hierarchy of needs’ and said that, for humans to reach their potential, they need to meet various needs. These needs range from basic needs (food, warmth, shelter and security), psychological needs (belonging, love and esteem), to self-fulfillment. We need to have our very basic needs met to be able to achieve the higher needs.

Maslow’s model leads into the idea that a range of factors influence health, and that maintaining your health and wellbeing needs a ‘whole person’ approach, focusing on all aspects of ‘you’, including:

•Your physical self.

•Your emotional wellbeing.

•Your social self (relationships and connections with others, living situation and finances).

•Your cultural identity (cultural heritage, dealing with racism).

•Gender-related aspects of you.

•Your occupations (what you do in relation to leisure or work).

•Your spiritual life (religion or spirituality, finding meaning in life).

To illustrate what it means to take a ‘whole person’ approach, let’s look at the story of a man called Alfred, who was going through very significant physical and mental health issues:

An occupational therapist was asked to see a man in his sixties called Alfred. He was from the remote outback of Australia, had recently had a heart attack and was recovering in hospital. He was feeling depressed as a result. He was descended from Afghani camel traders and as a young boy had learnt to create leather whips and saddles for camels — skills he had not used for many years.

At the same time, the therapist was asked to see two young men in the hospital’s burns unit, both of whom had burns to their arms. She got the men together and asked Alfred to teach the young men some leather work, as this activity would help function to return to their arms.

Alfred obliged over several weeks and the change in both him and the young men was remarkable. By doing something of value and tapping into his creative skills again, Alfred’s depression improved, and he returned home after his rehabilitation. The younger men recovered well too.

You can see that Alfred’s past story was very important, and what helped him recover was addressing him as a ‘whole person’. He was helped to connect with the young men, and to feel more empowered by teaching them some of his valuable skills. He regained a sense of purpose and identity, and his mental health improved greatly.

MEN HAVE VARIOUS LIFE STAGES

It can be helpful to remember that men age in ‘stages’. As a man ages, he heads into the middle years and then moves into the more senior years. These stages involve growing as a person. A young man is physically in his prime, usually becomes independent, finds his path in life, and possibly a partner. As a man moves towards middle age, life often becomes more secure, and he gains both experience and wisdom. An older man in his senior years tends to share his wisdom, pursue his interests and enjoy his family.

At each stage, there can be joy, such as starting a first job or becoming a father. There can also be many challenges, such as relationship issues, or finding a sense of worth after retirement. In the later stages of life, older men face their own mortality and experience various losses (such as health issues or the death of friends or loved ones).

Depending on your age and stage, there might be different parts of this book that speak to you. So please focus on the different parts of the book that you think are most useful.

WHAT DO WE KNOW ABOUT MEN AND MENTAL HEALTH?

Men and women have the same range of feelings but are taught by society to express and deal with them in different ways (more on this in a moment). Anyone can develop mental health issues, leading to mild or severe distress and possibly a negative effect on how they function in their day-to-day life. Here are some facts and figures about men’s mental health:

•Men experience a range of mental health issues, such as depression, insomnia (difficulty sleeping), anxiety, schizophrenia (an illness with psychotic symptoms including hallucinations and disturbances to thinking), substance-related issues, autism, dementia and post-traumatic stress disorder.

•Suicide rates in men are three times higher than for women and are a leading cause of death in young men globally. ²

•Substance use occurs at a rate of 3 to 1 in comparison to females.

•Young men suffer some of the most serious mental health issues, but many stay silent. Only 13 per cent of young men seek help for mental health issues. ³

•There are higher rates of some mental health issues in homosexual men, such as mood disorders including depression and bipolar disorder, some forms of anxiety, and eating disorders. Bisexual men are also at greater risk. Social stigma is thought to have a significant impact on the mental health of individuals identifying as gay, trans-sexual or with another gender or sexual identity. ⁴

•A key issue is that men are less likely than women to seek help for mental health issues, and they may delay or avoid getting help. Gay men, however, are more likely to seek assistance.

KEY POINT

Men are less likely than women to seek help for mental health issues due to many social stigmas that surround men’s mental health, such as feeling shame or the expectation that they be in control and not appear to be ‘weak’. We need to change this.

There are a number of potential barriers that stop men from seeking help:

•Ideas about masculinity and that being male means being ‘strong’ and having emotional issues or seeking help might mean being ‘weak’.

•The presence of mental health issues may mean ‘not being competent enough’ to solve the problem, ‘not in control’, or being vulnerable, and this might trigger a sense of shame.

•The stigma that exists in the community about mental health issues in general.

•Men seem to have greater difficulty in recognizing emotions than women, in part because of how they have been taught to push feelings down when growing up, and because they may experience emotions in different ways. Men are more likely to notice the physical symptoms of emotional distress before the emotional ones, so they may not realize they have mental health issues.

•When a man recognizes that there is a problem, he may decide to get help, but when he reaches out, he may feel very uncomfortable talking about his mental health. He may say ‘no’ to the help that is offered because of the reasons mentioned above.

Here is a story about a young man who found it difficult to recognize and express how he was feeling:

A 30-year-old soldier called Nate was directed to see a doctor on his military base by his senior officer, who had noticed Nate was withdrawn and angrier than usual. Nate denied any issues and answered ‘no’ to almost all the questions asked, so it was difficult for the doctor to assess what was going on.

The doctor organized to see him again two days later, by which time Nate was feeling very distressed and tearful. He was able to acknowledge that he was ‘not okay’ and had been feeling angry, very tired, was not sleeping well, and was struggling to relate to his partner. His greatest fear was being perceived as ‘weak’ by his colleagues. Nate and the doctor were able to identify that depression was the underlying problem.

There are also differences between men and women in terms of their nervous system. When women experience an emotion, the part of the brain responsible for the emotion (the limbic system) communicates with the parts of the brain responsible for language. Therefore, they are more able to talk about how they feel. In men, the emotional part of the brain communicates with the body, so men tend to feel the emotion in their body and express it through behaviours. A young man may feel angry and he expresses the feeling by hitting a wall, for example, rather than expressing the feeling in words.⁵

MASCULINITY

If you ask a young man about the male qualities they desire, they will often say to be strong, athletic, muscular, tall, have a job/career, be sporty, be sexually attractive, and so on. Where does this come from? A lot has to do with all the influences on boys and young men growing up (such as their families, school, religion and media to name a few), and the gender expectations in society.

Professor and author Brené Brown identifies a number of key ideas about masculinity in her research, including work being central to identity and being in control of emotions. Young boys are often taught not to express how they feel, but to fix the problem: ‘Don’t cry if you can’t hit the ball, just hit it (and) harder.’ And various cultures have different expectations and norms on how boys should behave.⁶

There have also been traditional ideas about what it is to be a man, such as being courageous, being in control, being the ‘breadwinner’ in a family or a protective father. Some of these ideas have had positive effects, but some have had negative effects, such as pushing emotions down or trying to take control through aggression.

You may have heard the term ‘toxic masculinity’, as it has been used a lot in the media recently, but do you know where it came from? It arose out of a men’s movement in the 1980s and was aimed at removing ‘limiting male stereotypes’ (males as ‘warriors’ or ‘kings’). In other words, the phrase was used to identify behaviours that were toxic to men, such as avoiding expressing emotions, shame, extreme self-reliance, extreme desires to dominate, putting down anything perceived as feminine in another male, or devaluing women. ⁷

The problem is that in recent times this term has been misused to infer that all aspects of masculinity are bad and toxic to women. This misuse has made it seem like masculinity is pathological, and this has caused controversy and a sense of ‘attack’ on men. Masculinity does not equal ‘toxic masculinity’. What the term intends to convey is that living up to rigid stereotypes about what it is to be male has contributed to many mental health issues, as well as to problems in the community such as domestic violence.

With all of this discussion in the community and media about masculinity, some men will have felt liberated, but others may have felt confused about their identity. We all need a sense of self, and it is stressful if the identity you have developed is challenged or threatened. We need to allow for differences among both men and women, as we all have different strengths, personalities and life experiences.

For all of these reasons, there is a need to explore new values for men and to take a stand against any damaging ideas about masculinity in our society. It is also vital to take a stand against unacceptable behaviours by anyone, whether that involves emotional, sexual or physical violence.

SHAME

Shame is a huge barrier to acknowledging there is a mental health issue and getting help. Author Tim Grayburn has written about how depression and anxiety impacted his life. He was reluctant to tell his family or partner about feeling anxious and depressed for many years because of a sense of shame. Tim has described the sense of fear that comes with a diagnosis of depression and that upon seeing a doctor and discussing the diagnosis, he had ‘images of being tied up in some dungeon’. He felt disappointed in himself, ostracized and ‘broken’.⁸ Tim went on to find ways to manage his anxiety and depression and is sharing his knowledge by writing and speaking