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Suffering in silence

John Smith is a farmer in this fictional scenario. He prides himself on being the strong, silent type who provides for his family and minds his own business.

But lately, John has been feeling blue. He is uncharacteristically anxious and lacks motivation to do his usual tasks. He yells at his wife and children over small incidents. He starts drinking in the evening to escape his feelings and help him sleep.

He never had to do that before.

Although John Smith is fictitious, the symptoms of depression and the illness itself are real. They are the focus of studies by Peter Kellett, a nursing instructor at the University of Lethbridge.

“In many ways, if we think about what we tell men they should be in society, we talk about the strong silent type who kind of just pushes on. I think you could probably put even more emphasis on that in a rural context,” said Kellett.

“There’s certainly a lot of emphasis in rural settings of men being sort of that strong, reliable guy.”

Those sorts of societal expectations make it more difficult for men to identify their own symptoms and seek help for depression, he said.

Statistically, depression rates are higher for women, at 6.5 percent of the Canadian population, compared to men at three to four percent.

However, Kellett thinks those statistics have been skewed by criteria in the diagnostic manual of mental disorders, which focuses more on women.

“We tend to not hear an awful lot about men and mental health because the criteria that we use to identify depression are probably not picking up men’s depression,” said Kellett.

Suicide rates in men support his contention.

“The enigma is that men in Canada consistently kill themselves at three times the rate of women,” he said.

“Although suicide is not always related to depression, there is a strong relationship, and so it suggests that we’re not capturing men’s depression very well.”

Kellett also wonders if the male suicide rate is even higher than statistics indicate because families are reluctant to reveal suicide as a cause of death.

He speculates that some accidents, which are the third most frequent cause of death in Canadian males, are actually a means of suicide.

Kellett’s research indicates men show depression in one of two ways, which he terms acting in and acting out.

Acting in includes alcohol, drug, gambling or sex addictions.

“You can kind of view this as men sort of self-medicating or numbing.”

Other examples include overeating or workaholism.

It can also evolve into compulsive behaviours such as an obsession with hobbies.

“They’re again trying to distract themselves from what’s going on in their life,” said Kellett.

The acting out type of depression includes anger, irritability, violence and crime. Suicide is of course the ultimate acting out behaviour, but excessive risk-taking can also be a sign.

“When men are feeling ‘less than,’ or they’re feeling subordinated in some way, they often do a hyper-masculine performance to try and compensate for those feelings of feeling ‘less than,’ ” he said.

“In many ways, it’s sometimes more acceptable for men to get angry that it is for them to cry.”

Kellett said male suicide rates peak at two different points in their lives: in their 30s and 40s and again when they are older than 75.

The stigma related to mental illness, combined with social expectations, prevents many men from seeking help for depression, said Kellett.

The other problem is access to mental health services, which can be particularly difficult in rural areas. Some provincial health care systems don’t fully cover mental health services, and they often require out-of-pocket payments for services.

“One of the big dilemmas, I think, for people that are facing mental health challenges is how do they even access these services,” he said.

“And for rural settings, of course, there is probably even less concentration of these services … or it’s going to involve travelling to a larger centre.”

Kellett said men’s social support networks are generally weaker than those for women, and men depend heavily on the women in their lives for that support.

The key for men who feel depress-ed is to reach out to someone, be it a spouse, relative, friend or doctor.

“I think the big problem, really, is the silence about this issue, and part of it is men’s doing,” he said. “Men don’t want to talk about it, and they don’t want to identify that they’re suffering from depression because it’s not viewed as a very manly thing.”

Kellett himself has struggled with depression and said he makes a point of being open about it to show there is no shame in acknowledging the illness and in seeking help.

He also believes more resources should be put toward treatment of depression. In 2013, 2,781 Canadian men committed suicide, which is a rate of 10.8 per 100,000.

In comparison, there were 505 homicides in Canada in 2013, which is a rate of 1.44 per 100,000. However, he said more resources are directed to crime than to treating depression.

“The issue of men’s mental health is not getting the attention it needs.”

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