The reasons for different experiences of mental ill-health between men and women are complex and speak to deeper problems in the structure of society, David Jamieson finds
THE PROBLEM has become one of statistical familiarity. In 2017, of the 680 suicides registered in Scotland, 522 were males and 158 female.
The picture is complicated. Women are far more likely to go to their GP to seek help for common mental health problems like depression and anxiety. Around twice as likely, with men around three times more likely to resort to suicide.
The further one delves into the figures the more complex the picture becomes. But most of it confirms a clear differentiation of the ways men experience and process mental ill health.
The sensitivity and complexity of some of the issues discussed in this article and in the adjoining podcast require a few things to be stated plainly. By no means are all men with mental health problems violent, dangerous or abusive. By no means all men who are violent or abusive suffer mental ill-health.
Mental ill-health can never be any kind of excuse for, nor full explanation of, male violence and abuse, including against women who are the most common targets of it.
Male violence is part of the acute power imbalance between men and women in the patriarchal mode of society. And it is this power imbalance, the impunity with which men so often act, and the misogyny which infects this mode of society - that structures male violence both towards women and towards other men.
According to Dr Simon Stuart, a clinical psychologist who has worked for eight years in adult mental health in Scotland, we cannot understand the relationship between masculinity and male mental ill-health without recognising its manifestation in men as anger and sometimes violence.
"We see a lot of men referred in with anxiety and low mood where anger is a big part of that" he says.
"One of the ways we might look at that is to say that for men anger has always been a more socially acceptable way of demonstrating distress.
"Men can go on for a long time being very angry, and then suddenly someone decides its become a problem, either someone themselves decides it's become a problem or someone else says its become a problem, and that's when they start to look for help.
"It’s very interesting and very saddening to work with men who have been brought up to be angry, because that is the type of society we live in."
The consequences for that pervasive anger include suicide and self harm, heavy drinking and drug addiction, loneliness and isolation, other forms of compulsive behaviour like over eating "and a traditional one for men, overwork".
"There's reasonably good evidence that unhappy men will sometimes throw themselves into whatever they are doing. That's problematic enough if you've got something to do, then again what is the outlet for that?"
Perhaps surprisingly, he says that addressing the relationship between masculinity and mental ill-health is not seen as a uniform or necessary part of clinical practice.
"It's an interesting one because it might well be that during the course of therapy we start to look at that and we start to address that.
"But of course its not my role to do that if its not something somebody actually wants to discuss and that can be very, very difficult."
But Stuart is also keen to avoid the notion that male violence towards women and the wider social problems created by a "toxic strain" in masculinity can be understood on the level of mental health alone.
"None of this is simple, none of this is linear and if we can fix X then Y will fall into place.
"There are multiple issues at play here. One of the many things that Me Too exposed is for just how long all of this has been going on, kind of tacitly accepted by other men. That's grotesque in itself.
"The question for us is how do we make the next generation of men better? It's not clear to me how well we are answering that.
"That's not a mental health question either" he adds, but one to do with the reproduction of gender roles in society and the socialisation of men and boys.
We live in "a society that still constantly brings-up men to think that's an acceptable way to be."
It would be wrong to think however that men always deal with trauma through violence or aggression. Kevin Welsh is a young man who was a victim of a serious violent assault in 2007.
"I kind of just bottled up all these feelings instead of overcoming the trauma. Never really dealt with it."
Then in 2013, and out of the blue he had a nervous breakdown: "My life just went downhill. Started having suicidal thoughts. I declined into depression and anxiety."
He found it increasingly difficult to leave the house, and suffered flashbacks to the attack when he tried. Inevitably, his relationships dissipated.
"I cut myself off from people, I couldn't face being out. I had a girlfriend at the time, I split up with her because it just kind of changed who I was. I just didn't want to do anything."
With his suicidal urges getting worse, he sought help that same year and was diagnosed with post-traumatic stress disorder.
As is so common with mental health problems, no single incident or cause is at root, but rather a complication of factors and experiences building up over the years. Delving deeper with his psychologist, Welsh discovered a legacy of accumulated trauma reaching back to childhood, including a string of sudden deaths and illness in the family, which coincided with the divorce of his parents.
The diagnosis hit him hard: "PTSD was the big one because men aren't supposed to be weak. There was a sense of shame, a feeling of weakness."
"Now I'm in a place where I've done so much good because of what happened. Trying to break the stigma so others don't feel the same as that."
Clearly, seeking help from professional psychologists and therapists can be lifesaving for men. But are all the suitable responses clinical?
Sandy McAfee is another psychologist, but he found the approach of the 'Mythopoetic men's movement' more effective in confronting his own issues after the death of a loved one.
"What I learned through doing my rights of passage, much more than what I learned through 30 years of doing psychology, was really helpful to me in being able to face emotion, and death and pain."
One of the central tenets of the movement, founded in the 1980s in the US by male writers and intellectuals stimulated by the ideas of the feminist movement, is that men lack a structured upbringing, and this has to be remedied with new traditions that emphasise the need for men to form emotionally meaningful relationships and be honest and authentic about themselves.
Divorced from structured relationships, men should re-examine cultural archetypes of men in order to restructure a healthier male identity.
As with so many other intellectual and cultural trends, it quickly migrated from the United States to the UK, where McAfee found it in rural Perthshire in the form of the Male Journey group.
"Lots of cultures around the world have initiations for young men. But that's practically absent in the West. So what happens is men make it up from themselves as they go along.
"They very often don't have any healthy role models. They are not getting any kind of initiation into manhood. Instead what's replacing it is kinds of gang culture, things like that. This is what he was experiencing in America."
"So they put a package together called men's rights of passage, of initiation for men."
He's both been through the processes of this movement and facilitated them as an initiated man, and experience that he describes as "transformative and powerful, both for me and for other men. So I can only speak really highly of it."
McAfee doesn't want to disclose the rituals and practices of initiation itself, because he says it requires to be encountered rather than simply read about. But it involves some form of emotional openness and vulnerability in a safe environment with other initiated men.
"The point of the whole thing is to help men to be authentic, to not bullshit themselves about whatever it might be. But to understand their grief and emotion and so on, and not to do anything harmful with it."
This men's movement, arriving at the juncture between psychoanalysis and 'new age' cultural disruptions will have the ring of hippydom to some, but that doesn't mean it cannot provide valid insights.
Some will be concerned with the idea of a 'men's movement' at all, let alone one that includes rituals and men-only initiations. It may draw to mind either the 'men's rights movement' with a considerable dovetail with reactionary, violent and far right tendencies like Incels in the United States, who have engaged in terrorist attacks targeting women in recent years. Or to the practice of men's secret societies and fraternities, whose internal dynamics can be elitist, manipulative or even abusive (think for instance of some university fraternities in the US).
But McAfee says "It's very respectful of women. It's not like any of this stuff we've heard about, internet groups and Incels and all the rest of that kind of stuff." I was left in no doubt of its broadly progressive intentions, at least from McAfee's perspective.
That still does leave one outstanding criticism, and one made by some feminists in response to the movement in its US heartlands - that its focus on a healthy masculinity based on folkish male archetypes has rendered it apolitical in nature, and disengaged from the wider structural critique of patriarchy. Some argue that its models of manhood are ultimately regressive, and represent a form of kick-back against feminist advances.
It is easily understandable how a community of men able to feel mutually emotionally honest about their lives could be therapeutic.
But crucial questions remain. Are the problems of masculinity fundamentally cultural or psychological in nature? Or do they relate to the deeper material realities of our society, and to its fundamental patriarchal relations?
An idea I came across both in the discussion of the culture and psychology of masculinity was that modern men were not 'whole' or emotionally rounded, but leaning on a partially formed identity. But what if this is the 'whole' masculine experience, and something that requires to be transcended completely?
Darren McGarvey is a Scottish writer and commentator, who also makes music under the alias Loki. His work, including his Orwell Prize winning book Poverty Safari and his recent track 'Don't Jump' both explore in different ways the juncture, or intersection, between mental health and social class.
Class is an unavoidable aspect of mental ill-health in Scotland, with both hospitalisation through mental ill health and suicide rates three times higher in the most deprived communities compared to the least deprived.
But, McGarvey says, it may also be part of the answer to the wider problem of male identity in society.
"First of all it's about making sure that the class analysis remains at the heart of what we do. Because it still has the deepest, most meaningful resonance for all of us."
"I don't think there actually is a great tension between class politics and intersectionality. I just think that class politics needs to be under[lying] it. Because actually we know that women, people of colour, people with disabilities, LGBT people, all experience poverty - which is because of class."
There may come a time when it must be accepted that masculinity itself is a barrier to finding solutions, both for men and for a wider society riven with dangerous hierarchies and inequalities.
Until then, the example of Welsh remains inspiring.
He started a public blog apologising to friends and family for the deterioration of his relationships.
From there he went on to volunteer for Victim Support Scotland, to help others who had suffered similar experiences.
This is someone who had every reason to be resentful, to feel angry at the world. But his way out was honesty, compassion and to apologise for any pain he had caused in others.
And that must be a strong starting point for change.
If you are going through mental health issues of your own and want to talk to someone, Mind offers this guide to helplines and mental health listening services.
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