Talking About Men's Health™

With summer rapidly drawing to a close, I pose a riddle, particularly relevant, as the days get cooler and daylight dwindles. When are competitiveness and ambition not competitiveness and ambition? When they’re depression. Okay, so it’s not much of a riddle, but as it turns out neither is the reason why 24,000 of the 31,000 people who commit suicide each year are men or why nearly four times more men kill themselves than women. Think you’re immune?

It is often touted that male depression is not as much of an issue as it is with women because depression in women occurs more frequently. However, the most recent research indicates that this is grossly inaccurate. Why? Unsurprisingly, the discrepancy appears to come from the fact that men and women may in fact exhibit symptoms of depression in different ways (shocking, I know). Men it seems do not display the traditional indicators of depression such as feeling sad, tired, or disinterested in once-pleasurable activities. Instead they express it primarily through aggression and most often channel this aggression into intense physical activity and/or extreme ambition. It may begin as an occasional hobby and then slowly accelerate until it spirals out of control, often leading to a point where the person hopes for injury or death as a means of escape. In 2008, Men’s Health magazine highlighted a former Ironman and power-lifter Raymond Britt who would routinely arrive at the hospital with blood pressure readings of 90/50 and would need four bags of IV fluids to rehydrate. Men’s Health reported “He eventually did 42 marathons, 27 Ironman Triathlons, and six ultra-marathons in 11 years, covering 42,000 miles, the equivalent of running, swimming, and biking around the world 1 1/2 times.” However, Raymond Britt admits that nothing about his behavior seemed odd and more often than not, individuals who achieve such feats are looked upon as heroes and role-models and are given impressive labels such as “ultra-competitor” and “Ironman”. Given that these traits are generally what society considers as normal male behavior, it is not surprising that researcher and professor of psychiatry at Harvard University, William Pollack, has estimated that between 50 and 65 percent of men go undiagnosed, suffering from what many refer to as “covert depression”.

What could be responsible for such an under-reported and potentially fatal phenomenon? The most obvious culprit is the way in which men in our society are expected to behave. As reported by Men’s Health magazine, Terrance Real, an expert in male depression and a marriage and family therapist, wrote “There is a terrible collusion in our society, a cultural cover-up about depression in men…Men have about a milli-second’s tolerance for feeling [this type of] pain, and then they spring into action. A flight from shame into grandiosity lies at the heart of male covert depression.” Quite often we are led to believe that there is not as much pressure on “21^st century men” to be the strong, stoic, emotionally-distant individual, all-but resistant to pain and suffering. Unfortunately most recent studies indicate that this does not in fact reflect reality. A German study published in the Journal of Affective Disorders found that the male-gender role is still characterized by all the traditional qualities such as invulnerability, aggressiveness, and fighting for control, dominance, and power. Furthermore, in the journal New Psychology of Men, research shows that while women and girls describe themselves in terms of positive traits such as caring, compassionate and an able to connect with others, men define themselves primarily through negatives. Men most often cited what it means to be masculine as not being weak, not being dependent on others, and not having a close connection to their mothers. This stigma has persisted despite countless studies dating back all the way to the 1950’s that “contact, affection, emotional communication, and genuine closeness are necessary for…humans, to maintain our health.” Additionally, men are conditioned to put less emphasis on creating and maintaining social support networks and it has been shown that isolation can have adverse effects on all systems of the body, including the brain.

The good news is that, once diagnosed, depression is easily treatable and no, I’m not talking about just with drugs. Therapy, healthy hobbies, good old family and friend support, or a combination of these can be just as effective and create a solid, lasting emotional base. Raymond Britt took up photography after being treated for his chronic depression and admits, “I never cared before. I never noticed the colors of a sunset. The electricity in a lightning strike. The glow of moonrise over a lake. They’ve always been there. But only recently have I begun to see them.” The really good news though is that we all have the ability to change the way we think, act and treat one-another. Let’s retain some of that traditional male independence and not let ancient societal dogma tell us how we ought to behave. From one 21^st century man to another, I think it’s finally time we let go of the unrealistic, nauseating, and unhealthy aspects of the traditional male machismo to which we all tend to fall victim. Our physical health wants us to, our mental health wants us to and goodness knows the ladies in our lives want us to. I challenge you this Labor Day weekend to watch some football, drink some beer, and then watch I Love You, Man. After all, if you’ve seen Forgetting Sarah Marshall, you know Jason Segel is a pretty secure guy and if he can say it so can you.

References

Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. Moller-Leimkuhler, AM. J Affect Disord. 2002 Sep;71(1-3):1-9

Men’s Health magazine. Exercising Your Demons.

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It’s a unique phenomenon of perception that causes us to be de-sensitized to small changes that occur over long periods of time.  We’ve all fallen victim to this at some point in our lives.  The extra slice of pizza each night during college that gave you the “Freshman 15”, that extra coffee at Starbucks every morning that drained $600 from your savings by the end of the year (and that’s just the small, excuse me, Tall), or perhaps even the Ambien prescription for your occasional insomnia that has now become a weekly habit. However, it has recently dawned on me that this culture of chronic neglect of proper health has reached truly frightening proportions.  What makes this even worse is the fact that the vast majority of those in society whose job it is to help us safeguard our health have seemed frustratingly indifferent and, in the case I’m about to make, have actively chosen to make the situation worse.

With Independence Day nearly upon us I felt it would be appropriate to honor our soldiers by focusing on a problem of particular importance to them. I speak of course of the massive increase in the medication provided to our fighting men and women abroad. A recent article in Men’s Health magazine provides a chilling tale of the enormous increase in prescriptions to active duty soldiers and the potentially disastrous consequences of heavily medicating a fighting force in the unpredictable and volatile areas of Iraq and Afghanistan.

Valium and Klonopin for anxiety; Zoloft, for depression; Ambien, for insomnia; Thorazine and Seroquel, anti-psychotics, used off-label to treat nightmares, and a host of other narcotics. In fact, the article goes on to include data from the Department of Defense that as of last year around this time, these prescriptions had reached nearly 50,000 a month, a 52% increase since October 2003.  Many of these soldiers are acutely aware of the side effects of these drugs on their ability to function at their posts, but are still ordered to continue their duties regardless. Corporal Michael Cataldi, who had been prescribed a regiment of Klonopin, Zoloft, Ambien, and narcotic painkillers, recalled having a fellow soldier kick the back of his seat every five minutes to keep him awake after being directed to drive a 14-ton armored personnel carrier, complete with canon, machine guns, and ammunition.  Each of these medications came with written directions warning against operating heavy machinery. To place this in perspective (as if it needs any), a U.S. Air Force flight surgeon interviewed for the article went on to point out that “even in peacetime, people in the many combat-support positions…would not be allowed to take such medications and continue to work in their sensitive, demanding jobs.” Indeed, even a civilian construction company would not allow an employee to operate heavy machinery who was taking even one of the four prescriptions used by Corporal Cataldi.

Perhaps even worse than deploying over-medicated troops, is re-deploying them.  Officially, Pentagon policy states that soldiers receiving treatment for psychiatric conditions must have proven stable for a minimum of 3 months before being allowed to return to combat.  However, in practice this is not often the case.  One staff member of a team sent by the Army Surgeon General to investigate medicated soldiers who have returned to battle, admitted “many of these soldiers are sent to Afghanistan…despite a doctor saying they shouldn’t go or leaders knowing they shouldn’t deploy.”  One particularly heartbreaking example is that of Michael R. De Vlieger, a gunner with the 101^st Airborne.  After surviving a grenade attack that drove his knee through a Humvee door, De Vlieger’s mental health slowly deteriorated to the point of complete psychotic breakdown.  After spending two weeks at a psychiatric hospital and prescribed four different prescriptions to treat his symptoms, De Vlieger found himself headed back to the combat zone a mere 18 hours after his release.  He admits, “I was in no condition to leave, I’m an infantryman.  If I’m screwed up in my head, it could cost my life or the lives of the men with me.”  In other words, De Vlieger was forced to choose between his own mental well-being and the safety of his fellow soldiers.  He threw his pills away.

It is true that soldiers have been medicated in various ways since the dawn of civilization, most often with alcohol and decidedly self-administered. However, in recent decades the steady rise in prescription medications in our armed forces has reached a critical point where it presents a serious threat, not only to individual soldiers, but to national security as well.  In these days of an all-volunteer Army, fighting in a distant land, it has become shamefully apparent how easily the American public has forgotten about their men and women in uniform.  It was outrageous enough that we allowed our troops to go for so long without adequate protection for their bodies, so why should we be any less furious about not securing their minds?  Regardless of how you feel about the war itself, the sacrifice that these men and women make on our behalf speaks volumes about them.  If we send them to perform their duty being anything less than all they can be, what does that say about us?

I just started reading a book titled “The Accidental Asian,” by Eric Liu, a former speechwriter for President Clinton. The first few chapters, dedicated to his late father, described poignant memories he carries with him. One memory was particularly captivating. Liu described his late father’s bout with kidney failure and their family’s struggle to keep the illness private, as requested by his father to “save face” and to ensure that he wasn’t treated differently for being sick. I immediately started to reflect on my own life and imagined myself in that situation. Would I be honest to friends and family about my illness? Would I be open to receiving help and increased attention from friends and family? Would I downplay my illness and act as if nothing was wrong?

I feel that Liu’s father had a natural response to his illness. Regardless of being raised in a culture that values pride and privacy, it seems natural to respond in such a manner. From a biological perspective, it’s survival of the fittest and the weak are distinguished from the strong. However, we live in the 21^st century. As a society, we have evolved to think in a rational manner. We have access to education and can make informed, rational decisions. We have the ability to communicate our needs as well as the ability to find the necessary resources to restore our health and well-being. It is our personal responsibility to take our health into our own hands. A couple of ideas to get you started:

• Assess your health status by obtaining a thorough physical examination or participating in health screenings available in your community.
• Educate yourself on the risk factors for diseases such as cancer, heart disease, diabetes and others to become aware of potential problems.
• Set achievable health goals in areas you want to change (i.e. lifestyle changes including diet and exercise, stress management, etc.).
• Ask for help!

Imagine yourself in 5 to 10 years…wouldn’t you want to be healthy?

Welcome!

Talking About Men’s Health (or TAMH) is a blog designed to provide a platform for the discussion of a wide range of issues effecting boys, men and their families.

I’m soon to be joined here by a range of key thought leaders who will share their views on a wide range of issues they care passionately about. The writers have been specially invited, and I would like to invite you also to contribute to the debate via the comments section. It’s my hope that with our contributors and readers comments the site can become an open platform for discussion on the issues.