Editor's Note: This hour discusses suicide, anxiety and other mental health issues.
If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting 741741.
Men and anxiety. New studies show that men don’t experience or express anxiety in the same way as women. That could be affecting men’s access to treatment, and their mental health.
Michael Addis, professor of psychology and director of the Men’s Well-Being Research Group at Clark University. Author of "Invisible Men: Men’s Inner Lives and the Consequences of Silence" and co-author of "The Psychology of Men in Context."
Stefan Hofmann, professor in the clinical program at Boston University, where he directs the Psychotherapy and Emotion Research Laboratory. He’s also affiliated with Boston University’s Center for Anxiety & Related Disorders. Author of the forthcoming "The Anxiety Skills Workbook: Simple CBT and Mindfulness Strategies for Overcoming Anxiety, Fear, and Worry."
Mark Farley, founder of an on-campus chapter of Active Minds, a mental health advocacy group, when he was a student at Rhodes College.
On anxiety among men
Michael Addis: "Anxiety is extremely common in human beings, in general. And, in fact, we'd be in a boatload of trouble if we didn't have the capacity for anxiety. It's really our bodies way of telling us that there's a threat that we need to pay attention to. But, of course, with an anxiety disorder, there often is not a real threat. And, instead, our body is responding as if there is. So, that's the challenge. We know that men — compared to women — are about half as likely to be diagnosed with an anxiety disorder. But, of course, the big question for people who do research in this field is, ‘Is that really an accurate estimate?’ Or, are some of these cultural mandates … particularly for men around suppressing fear and vulnerability … is that distorting our understanding? In other words, we're underestimating how common this is among men.”
Stefan Hofmann: “We distinguish a lot of different categories of anxiety disorders. So, social anxiety disorder is probably one of the most common ones, and there’s generalized anxiety disorder, there’s specific phobias. … So it depends on the categories. We know that for social anxiety disorder, men are about equally affected than women. For generalized anxiety disorder, specific phobias, panic disorder, women are more commonly affected than men. Why that is, is a good question. It’s puzzling. Probably social factors, cultural factors that play a role. … There are also interesting differences in different cultures. And especially in Asian vs. Western cultures. There are differences in the expression, and also the experience of anxiety.”
"There does seem to be some clinical wisdom, and a great deal of anecdotal evidence from people that work in mental health — and from people that study men's lives — that when men struggle with fear, and depression, as well, it can tend to come out more as anger and aggression."Michael Addis
On how anxiety is different for men
Michael Addis: “There does seem to be some clinical wisdom, and a great deal of anecdotal evidence from people that work in mental health — and from people that study men's lives — that when men struggle with fear, and depression, as well, it can tend to come out more as anger and aggression. That said, we don't, as yet, have definitive scientific evidence of that. But, I can tell you, for example, anecdotally, one of the things that got me into this area of research was that I was working on an anxiety treatment center, on a research study, and I ended up interviewing a man who was having daily panic attacks. And a panic attack is an overwhelming sense of anxiety and fear that comes on very quickly. You can be dizzy, nauseous, have a sense of unreality. Here's the kicker: he was actually a construction worker working up on those scaffolds, 30 stories up in the air. And having daily panic attacks. And it's been going on for 10 years. And he had not sought treatment, because he felt that this was a weakness on his part. That if he had more character — or, I might say, if he had more masculinity, as socially defined — he would have been, he thought, in his own mind, able to deal with that, and conquer it.”
Stefan Hofmann: “It's very much of a socialization issue. And men in our culture are more encouraged to use, let's say, strategies such as substance use, alcohol, to suppress their emotions. Or, to act out emotions in an aggressive way that's more socially acceptable, as compared to women. They are more encouraged to talk to their friend, and to bottle it up, and to perhaps kind of withdraw and become passive. So, this is very much in line with, ‘How do we regulate our emotions in a culturally adaptive way?’ ”
On the link between anxiety and suicide in men
Michael Addis: “One thing we've known for several decades is that men take their lives at about four times the rate that women do. And suicide is often set in motion by — regardless of the mental disorder that might be, or might not be, surrounding it – it’s set in motion by narrowing of vision, a hopelessness, the sense that things are not going to get better. And [also] the idea that the air that men breathe, on a large scale — which creates these mandates for handling problems on your own, being a success, always keeping your weaknesses to yourself, and so on. It’s not hard to see how that would heighten that sense of hopelessness, if you are, in fact, facing something like chronic anxiety. So, there's certainly a link there.”
"Showing them that they're not by themselves, and that there are multiple different options and avenues in which they can proceed in treatment, or even talk about anxiety, is huge now."Mark Farley
Mark Farley, on toxic masculinity on college campuses
Farley founded the on-campus chapter of 'Active Minds' — a nonprofit organization that raises mental health awareness on college and high school campuses — when he was a student at Rhodes College.
Mark Farley: “One of the things that 'Active Minds' — and working with the organization, and programming activities — really showed me, was that it's OK to be vulnerable. That you're not the only person that is suffering from anxiety or pressure, bipolar disorder or suicidal ideation. And that, in reality, silence truly hurts us all. Like, if I'm not being honest and talking about what I'm going through — whether it's with a friend, significant other, a family member or a treatment provider — it makes my life a whole lot more difficult. And, so, by being able to show people — by being able to show students … especially men — that it's OK to be vulnerable, it's OK to talk about your feelings. [That] it's nothing against one’s masculinity. I mean, the concept of masculinity is toxic right now. … Just being able to create a conversation on a college campus, where the majority of men — some are using alcohol, some are using drugs, sex, over-exercising, eating, in order to try and cope with those anxieties. Showing them that they're not by themselves, and that there are multiple different options and avenues in which they can proceed in treatment, or even talk about anxiety, is huge now.”
From The Reading List
Wall Street Journal: "Anxiety Looks Different in Men" — "When a man explodes in anger over something seemingly insignificant, he may appear like just a jerk. But he could be anxious.
"Anxiety problems can look different in men. When people think of anxiety, they may picture the excessive worry and avoidance of frightening situations that often plague those who suffer. These afflict men, too. But there’s a growing recognition among psychologists that men are more likely to complain of headaches, difficulty sleeping and muscle aches and pains. They are more likely to use alcohol and drugs to cope with anxiety, so what looks like a drinking problem may actually be an underlying anxiety disorder. And anxiety in men often manifests as anger and irritability.
"Anxious 'men may present as loose cannons, but they are worriers,' says Kevin Chapman, a clinical psychologist in Louisville, Ky. 'Aggression tends to be more socially acceptable to many men than anxiety.'
"Studies have found that about one in five men (and about one in three women) will have an anxiety disorder during their lifetime. But psychologists are increasingly concerned that those numbers underreport male cases."
Harvard Business Review: "How Men Get Penalized for Straying from Masculine Norms" — "When women behave in ways that don’t fit their gender stereotype — for example, by being assertive — they are viewed as less likable and ultimately less hirable. Does that same hold true for men? Are they similarly penalized for straying from the strong masculine stereotype?
"The short answer is yes. Research demonstrates that men too face backlash when they don’t adhere to masculine gender stereotypes — when they show vulnerability, act nicer, display empathy, express sadness, exhibit modesty, and proclaim to be feminists. This is troubling not least because it discourages men from behaving in ways known to benefit their teams and their own careers. Let’s look at each of these behaviors:
"Showing vulnerability. Men are socialized to not ask for help or be vulnerable — and they can be penalized when they challenge this notion. An informative set of studies from 2015 finds that when male (but not female) leaders ask for help, they are viewed as less competent, capable, and confident. And when men make themselves vulnerable by disclosing a weakness at work, they are perceived to have lower status. This is problematic, as not seeking help when you need it or admitting areas for improvement inevitably leads to mistakes and less development."
Slate: "Men Get Stereotyped Too. It’s Time the Court Acknowledges It." — "What does it mean to be a man? As the stereotype goes, a 'real man' is athletic, a provider, virile, and confident. He is strong, definitely heteronormative, and preferably tends toward hypermasculinity. These stereotypes of masculinity are as damaging to men as they are to the women impacted by the behavior they inspire.
"The trilogy of cases the United States Supreme Court will hear on Tuesday, R.G. and G.R. Harris Funeral Homes v. EEOC, Altitude Express v. Zarda, and Bostock v. Clayton County, are, at their core, about masculinity. The first case deals with transgender rights, and the other two concern sexual orientation. Together, they will force the court to take up the question of whether sex stereotypes are a reason to protect people who are assigned male at birth when they transition, or when they deviate from heterosexual norms. Workplace protections have already been expanded to combat discrimination against women based on stereotypes of femininity. They must also include protection for behavior that deviates from the binary definition of what it means to be a man."
This program aired on October 14, 2019.