Written By: Dr. Keith Hariman, Specialist in Psychiatry
2020 wasn’t a kind year to Jason.
As the manager of several restaurants in Hong Kong, Jason had to go through multiple periods of very few customers and even forced closures due to the Government's COVID-19 policies. Business was so bad that at its worst, he only had two covers for dinner on one evening, compared with the usual 80% plus occupancy every night before 2019. The landlord wasn’t giving out any concessions with the rent, so the costs kept piling up. With no end in sight to the restrictions, Jason was forced to lay off several of his employees and put most on unpaid leave, even though he knew it would be hard to find another job. He had no choice with pressure from the restaurant owners. The guilt he felt after handing out a severance letter was simply too much.
Thus began his journey with alcohol. Jason only intended to use alcohol as a way to help him fall asleep at first. However, he began to drink more and more every night, partly for sleep promotion, but also partly to help him drown his sorrows as he worried about his restaurants every single day. Not only did he feel more upset, but he also became rather agitated and irritable, often lashing out at his staff or his wife over minor transgressions and mistakes, only to regret his actions afterwards for losing his temper so easily. He found it more difficult to fall asleep and didn’t eat much. He stopped hanging out with his friends, preferring to just stay home and drink rather than seeing them. He also stopped playing tennis, initially because the courts were closed, but even after the courts were reopened, he simply lost the willpower and motivation to play. When things were at their worst, Jason even contemplated harming himself as the psychological pain was too hard to bear.
Jason was only brought to medical attention a few months after his mood had deteriorated. This delay in getting treatment was partly because of his own reluctance, insisting that he was only going through a low period in life, and fearing the associated stigma of weakness. He was worried that if ‘the lads’ knew that he was in such distress, they would either laugh at him, not understand what he’s going through or tell him simply to ‘snap out of it’. When his wife encouraged him to seek treatment, he would often shout back at her and told her to stop nagging. The turning point only arrived when his wife broke down in tears one day and said that she couldn’t bear living with him anymore.
As with many other men, Jason’s story is one we see too often. Both genders suffer from largely similar proportions of mental illness as a whole, with only minor differences in the relative prevalence of certain mental disorders. However, compared to women, men seem to be more reluctant in seeking mental health treatment, with women being 1.14 to 1.6 times more likely to look for help in countries such as Australia, the United Kingdom and the USA. Furthermore, though men overall report fewer self-injurious behaviour, they don’t tell others about their suicidal ideation as much and are thus 3.5 times more likely to succeed in suicide attempts. Numerous studies have tried to come up with hypotheses to explain this difference in help-seeking behaviour, with suggestions such as the traditional masculinity stereotype of invulnerability and self-reliance, divergent coping mechanisms of relying on self-medicating or alcoholism and poor mental health literacy amongst men. As such, problems of depression, as with Jason, and anxiety often get overlooked and undiagnosed for long periods of time, leading to long periods of suffering for individuals and their family members.
Jason’s condition was managed effectively through a combination of antidepressants and cognitive behavioural therapy. Coupled with the rebound in the economy, the slowing down of COVID-19 cases and easing of restrictions, thus better business at the restaurant, the depression soon went into remission and he is able to live life now mostly like before (bar the visits abroad that we all crave for). The bigger problem, however, is the difficulties that mental health professionals encounter in trying to identify individuals like Jason earlier, so interventions may be delivered more promptly. There has been research looking into various behavioural change techniques to encourage men to seek treatment if the need arises, such as the use of role models to convey information, incorporation of the content that builds on positive male traits (eg. Responsibility and strength), psychoeducational material to bring awareness, and signposting services. There isn’t a single most effective technique, as different people would respond to different cues. Nonetheless, it is hoped that with these strategies, the curtain covering the stigma on mental illness can be torn down and we can have a conversation about men’s mental health.
1. Sagar-Ouriaghli, I., Godfrey, E., Bridge, L., Meade, L., & Brown, J. S. L. (2019). Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking. American Journal of Men's Health. Retrieved November 2, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560805/.