According to the Diagnostic and Statistical Manual of Mental Disorders 5, symptoms of depression include the persistent sad, anxious or ’empty’ mood; feelings of hopelessness and pessimism; feelings of guilt; worthlessness or helplessness. Too often depression is referred to as the “common cold” of mental illness and is routinely positioned by healthcare providers and the media as a women’s mental disorder. But male depression has taken center stage recently with the suicide attempt of football player Clark Carlisle. Newspapers showed the bruised and tearful footballer appearing raw and vulnerable as he left a psychiatric hospital, the front page provokes thoughts of a modern day version of Bedlam – treating the mentally fragile as entertainment. This idea of mental pain as entertainment is highly dangerous and possibly prevents others, men in particular, from seeking help. Men and depression is severely under researched and not on the public’s radar. Men are diagnosed at lower rates than women but suicide rates in the UK are currently three times higher for men than women. Yet despite this women are subjected to less mental illness stigma than men. According to author Matt Haig, depression is the deadliest disease on the planet, killing more people than any other form. Reasoning for this is that many men may find it difficult to seek help because of the hegemonic forms of masculinity, which is characterized by emotional control and lack of vulnerability whereas depression is associated powerlessness and uncontrolled expression of emotion. Numerous articles show that stereotypes about people with mental illness’ focus on violence and dependency and how they map onto sex role stereotypes. However the literature on this issue is steadily growing and in order to better understand men’s mental health, the relationship between social construction of ‘masculinity’ and health beliefs needs to be explored. It is important to acknowledge and not generalize all men as silent in their depression and ending in suicide. Suicide is a style of depression that is common in men, but it is not universal. Here I discuss the social construct of masculinity, how it is failing men with depression and what can be done to change this so depression is viewed as a common human experience and not a male weakness.
‘Hegemony’ refers to power and the insidious process of domination where the majority of people come to believe that particular ideas are not only natural but are there for the benefit of society. The concept of hegemonic masculinity has often been used in attempts to understand men’s experiences and expressions of depression. Connell’s concept of hegemonic masculinity is perhaps the most popular approach to gender in academia at present. It focuses on the social aspects of gender and according to Pete Branney and Alan White in their article, Big boy’s Don’t cry, enacting depression is to enact gender. According to Jukka Valkonen and Vilma Hanninen hegemony refers to practices and structures in society that define the norms and values according to which a man is expected to behave and experience. This is reinforced in an article by sociologists Carol Emslie et al who states that hegemony is the “winning and holding of power by white, middle class, heterosexual men who then set the standard for other men.” Fellow sociologist Warren furthers this idea and argued that depression is incompatible with masculinity in three ways; firstly expressing emotion and crying is linked to femininity, secondly masculinity equals competence and achievement and finally to be masculine is to be tough and self-reliant. Emotional control and denial of vulnerability are important parts of hegemonic masculinity, therefore denial of depression is one of the means men use to demonstrate masculinity and avoid assignment to a lower status position. In our society there is multiple insults to differences in masculinity, men are labelled as weak or sensitive if they do not conform. Famous sociologist Ken Plummer suggests that homophobic insults are used to delineate acceptable and unacceptable male identities amongst boys in their early years, crucially shaping masculinities for both gay and straight men. This creates a “circle of legitimacy” and any man who deviates from this is labelled as culturally subordinate. However as Carrie Paechter suggests, most of the time gender identity is taken for granted, yet worryingly there is some evidence that pressure of conformity to the standards of hegemonic masculinity plays a part in suicidal behavior. Ultimately in the industrialized Western world, strength, competence and rationality are appreciated as central masculine attributes. These ideals affect a man’s life, irrespective of whether he conforms to them or not.
As stated before, men are diagnosed with depression at lower rates than women are, yet men commit suicide four to fifteen times more often. This is due to the complexity of masculine attributes to suicide. Canetto interestingly puts forward the view that nonfatal suicidal behavior is associated with femininity, whereas suicide is associated with the masculine. Thus, surviving a suicide attempt is perceived as particularly inappropriate behavior for males, suggesting that suicide takes courage – another masculine attribute. Whilst suicide is not classified as a mental disorder, Emslie states that major depression underlies more than half of suicides. Studies routinely suggest that depression is part of an inner emotional world that is contained and constrained by gendered practices. Brownhill et al developed the ‘big build’ which is a descriptive model used to help explain how masculine practices in relation to depression result in a debilitating trajectory of destructive behavior and emotional distress.
These behaviors then may escalate to violence and suicide. From this concept depression in men is not masked or hidden but may be visible through abusive and destructive practices. Branney and White make it important to note is that this is not exclusive to men, women can ‘do’ masculinity and may cope with depression in similar ways. According to the charity CALM (campaign against living miserably), men account for more than three-quarters of all suicides in England and Wales, yet three out of four had no contact with mental health professionals. In her book The Patient Paradox, Dr. Margaret McCartney explains that the severely depressed are in too much pain to make plans to end their life. It is when a person is beginning to recover that suicide becomes an option, especially if they are male. If we understand masculine hegemony it becomes apparent that suicide isn’t biological but cultural. By observing how the suicide rates have changed, how they go up and down over the past fifty years, it becomes obvious that our culture and what we expect from it is to blame. For example, being unemployed at a young age has long term effects on ones mental health. Research by the Samaritans reveals that if you are male and in the poorest socioeconomic status, you are ten times more likely to commit suicide than those more affluent. Men have experienced “dislocation” as they have increasingly lost their role as breadwinners. According to Owen Jones, Britain’s rapid de-industrialisation played a huge factor in casuing depression amongst men. This is still being felt today as skilled apprenticeships are not awaiting many of the young men now leaving school and being unemployed at a young age leads to increased anxiety and depression.The uncomfortable truth is that the masculine hegemony is killing men.
Because depression is such a taboo subject in the masculine world of football, it is has been extremely significant that footballer Clark Carlisle has been open and honest about his eighteen month struggle with depression. He has explained that the end of his career, his struggle with alcohol and financial problems led him to feel a lack of “a sense of worth and value in life.” This January we saw him try and take his own life again by jumping in front of a truck.
In his many emotional interviews, Carlisle has explained that when his wife was diagnosed with postnatal depression, he advised her to “get a grip”, it wasn’t until he looked at the list of symptoms did he recognize his own feelings as depression. These symptoms included lack of energy, sadness, negativity and self-destructiveness. It seems that many men are reluctant to go to their GP and fail to identify their own symptoms as depression, as in the case of Carlisle feeling sad or low was a weakness and you simply just had to pull yourself together. Another survey by CALM revealed that sixty-nine percent of men said they preferred to deal with their problems themselves and fifty-six percent didn’t want to burden others. This makes it clear that the traditional masculine hegemony surrounding depression is increasingly failing to protect men from themselves. Carlisle’s realization and his emotional narratives of his suicide attempts has encouraged many other men, especially in the sporting world, to seek help and he is now an ambassador for the charity Mind. His documentary, Football’s Suicide Secret, is extremely powerful as he talks in depth about his crippling mental pain, encouraging education of depression in order to end the stigma and how talking about depression is extremely cathartic. He also interestingly points out that there is no logical trigger to depression, it is something that just happens to anyone and just like a physical illness, it needs diagnosing and treating.
Recovery narratives are also explored in Emslie’s study, where male accounts of depression are examined for connections between depression and social constructions of masculinity. The study revealed that as a part of recovery from depression, it was important for men to reconstruct a valued sense of themselves and their own masculinity. It highlighted a range of emotions the men felt with vivid imagery of isolation; “like being in a glass tube where you could see everybody but you couldn’t reach them.” Many of the men recounted their depression journey with many involving insults to their sense of masculinity. They described being labelled as ‘weak’ and ‘sensitive children’ by friends and families, this retorts back to Plummer’s idea of homophobic insults being used to shape masculinity. The ‘macho’ school environment was continuously mentioned throughout the narratives and how it did not encourage boys to express their emotions. One participant was quoted stating;
“At that age, 17, school kid, pretty macho, tough environment I think, not a place you could really talk about feeling bad and not really possessed of a vocabulary. yyou feel really alone, you feel weedy, you feel cack, you just think that you’re no good.”
Although the study was not about suicide, many of the respondents revealed they had experienced serious suicidal thoughts and some discussed their suicide attempts. Yet the men interviewed were all stable for an interview and the majority were on recovery. Emslie explains depression as simply a continuous construction, destruction and reconstruction of one’s self in the face of problems. Her research then goes on to portray how the respondents recovery narratives were used to maintain a valued sense of their selves as men.
The recovery narratives in Emslie’s study show an emphasis on an importance of moving from dependence to independence, especially in terms of gaining a degree of control over their healthcare and medication. This for many was an important part of recovery; reducing dependency on others. One participant stated that;
The relationship between establishing control and medication is one that appears to be extremely common, whilst some resisted medication, others saw it has helping them regain control not causing them to be dependent. In the study others drew on traditional concepts of masculinity, conceptualizing depression as an entity that could be ‘fought’ and putting an emphasis on ‘strength’, ‘anger’ and ‘control’ to pull themselves out of depression. More interestingly, many other men put emphasis on their depression making them different and embracing their diagnosis as a positive feature of their identity. A mechanism that Emslie found consistently used was to compare themselves to real or fictional characters who had also suffered from depression, such as write Ernest Hemingway. Emslie concludes that by drawing these comparisons it is important to note that men with depression often have other qualities such as more intelligence or emotional sensitivity. Emphasis on difference allowed men to discuss changes in themselves that many other men might have found difficult within the constraints of traditional masculine discourse. This study shows how respondents used varied and creative strategies to try and rebuild their sense of masculinity, whilst many drew on values associated with hegemonic masculinity, others constructed a narrative based on difference.
Whilst Emslie encourages men’s recovery from depression by reconstructing one’s self image, there has been numerous other suggestions about how to promote awareness of depression and provoke men to seek help. This year CALM released a much needed four-point charter to encourage change and attitudes toward male depression. It includes a shift in thinking about the needs of males in schools, workplaces and public services but more crucially focuses on fuller range of expression of masculinity in the media and advertising. Challenging unreconstructed masculinity is a priority and campaigns have been launched encouraging men to challenge “anarchic male stereotypes” and “define themselves in their own terms”. As we have seen in the case of Clark Carlisle, men speaking out helps encourage others. Emslie’s article also goes on to suggest that healthcare professionals should teach men with depression about the importance of gender in order to help them resist masculine hegemony when it comes into conflict with life goals. Nevertheless, healthcare services currently lack the expertise required for providing solutions specifically targeted at men, ‘health’ is still viewed as a women’s issue. According to Jukka Valkonen and Vilma Hanninen, mental health diagnostic tools may ignore men’s depression because of men’s unique ways of expressing or concealing their mental distress. This year the UK has piloted a “zero suicide” policy that asks the community to look out for each other, teaching warning signs and offering help not exclusion. However according to Owen Jones’ article for the Guardian, UK mental health trusts have cut funding by twenty percent and beds by ten percent in the past three years, despite warnings from mental health charities that these cuts to services are risking people’s lives. Another huge problem with the British mental healthcare system is that it is aimed at treating illnesses as they happen, instead of preventing them in the first place, which is perfect for the drug companies. Jones finishes his article with the profound statement that the stigma of mental distress, especially toward men, makes such services easier to attack, which I find myself strongly agreeing with, as depression and suicide can be avoidable and not inevitable.
It is still the dominant paradigm that depression is caused by a chemical imbalance of the the brain, but depression is simply a human experience. It does not define you, it is something that happens to you and you are no less of a man or woman or a human for having depression than you would be for having cancer. There needs to be more emphasis on talking, listening and encouraging discussion in order to tackle the severe stigma attached to depression. Emslie’s study suggests that it is important for men with depression to reconstruct a valued sense of themselves and their own masculinity as a part of their recovery from depression. The study also highlights the importance not to generalize all men and depression, some men will talk about depression if they are given the right circumstances they will talk openly and honestly about their experiences. Speaking out and challenging the stigma of male depression is certainly courageous, especially because the masculine hegemony in our society is incredibly powerful. With the likes of Clark Carlisle, society is is starting to recognize and talk about mental health issues more frequently. However depression still remains a taboo subject for men and more needs to be done to recognize and prevent mental pain if the male suicide statistics are to be reduced. Male stereotypes, rising socioeconomic insecurity and healthcare cut backs are all detrimental factors that increase the risk of more lives becoming endangered as they simply do not feel comfortable seeking help for something so stigmatized by masculine hegemony.