By Mark Wolf
Most maladies are unencumbered by shame and stigma. Yet for many men to acknowledge they are uncomfortable with the way theyre feeling maybe down, irritable, unmotivated, fatigued, feeling as if life might not be worth living, and, yes, maybe there are some issues down there requires a leap most men seem hesitant to take.
Men are stubborn. We dont want to talk about our feelings. We are very leery and afraid of being labeled sissies, afraid of looking weak, and a lot of those things apply when youre talking about mental health, said Matt Vogl, deputy director of the University of Colorado Depression Center.
Theres this perception that Im not as macho when I ask for help. The pervasive attitude is bite your lip, suck it up, pull your chin up off the bar. We should take care of this stuff on our own. As a result its very hard to get men into treatment and keep them in treatment. A man goes to the doctor for high blood pressure, gets medication and gets better. Therapy is often a long process.
Mental health professionals are frustrated that not enough men are walking through their doors to seek treatment. Vogl and his colleagues at the Depression Center are attempting to find ways to connect with this hard-to-reach group.
Men arent going to watch a PBS show on depression but they might if they hear about it at an event that appeals to them in another way, said Vogl. Our job is to create that cheese and put the pill inside.
An ad campaign launched this week uses humor to nudge men into seeking help.
Mantherapy.org and a 30-second public service announcement are the centerpieces of an effort that spans viral videos on social networks, billboards and a community outreach network in 26 Colorado counties. It includes coasters to be distributed to bars, restaurants and golf courses.
The campaign is produced by the office of suicide prevention at the Colorado Department of Public Health, Cactus Marketing Communications and the Carson J. Spencer Foundation. It was funded initially by a grant from the Anschutz Foundation.
The site features Denver actor Ron Arp as Dr. Rich Mahogany, a therapist whose office is a place where men can be men and whose pitch to men is a riff on myriad manly touchstones from take a knee and form-tackling to a love of chainsaws and disdain for shopping malls and Spandex.
Underlying the humor is straight talk about anger, stress, substance abuse, layoffs and suicidal thoughts as well as links to Gentlemental Health, mental health resources and testimonials from men who have dealt with depression and other issues.
The site is an acknowledgment that men dont access mental health services the way they should, said Jarrod Hindman, director of Colorados office of suicide prevention. Historically, suicide prevention marketing and education materials really promoted the notion that its OK for men to ask for help. Men are doers. We want to provide men with an opportunity to experiment with tools to allow them to try to help themselves.
The other objective is to change the way men view mental health.
We want people to think, I have high blood pressure, I go see my doctor, medicate it, Im better. We want mental health to be the same thing, said Hindman. The reality is the treatment success rates for things like depression are very high.
Use of humor questioned
Much deliberation and research was involved about the role of humor in the campaign.
We had some concerns with how the suicide prevention community and mental health professional community would respond, said Hindman.
To address that, they assembled a group of advisors who are leaders in suicide prevention. Some of the feedback suggested that humor resonates with men.
Were confident weve done good background work, he said.
We were somewhat apprehensive, said Hindman, but from Day One we really charged Cactus to push the envelope because we thought thats what was required to target men.
Depression Center not yet on board
CUs Depression Center is a resource on mantherapy.org, but the center has not formally endorsed the site.
I still have some concerns about how its going to be received, said Vogl. The target group, men who are going onto the Internet and seeking some help, are the ones we might be able to get into therapy, and were afraid we might scare them away with the message that all they need is self-help.
I think it does fill a void to try a different approach to reach a really hard-to-reach audience so I applaud the effort. Ultimately I think its going to be a good thing, he said.
Among the outreach targets for the Depression Center is the first-responder field, a group Vogl characterizes as predominantly male and particularly averse to talking about their feelings.
When a team from the Depression Center talks to first responders about how to recognize the signs of a potential suicide when they are called to the scene of an emergency, the hope is that the responders also will become attuned to signs of trouble among their colleagues.
Were teaching people how to ask others about their suicidal tendencies: Are you OK? Is something going on? with the hope theyll help one another, said Vogl.
The sports connection
Sports is often a vehicle to reach men.
Bucky Dilts, whose ability to nestle punts out of bounds deep inside opponents territory helped the Denver Broncos win the 1977 AFC championship and earn a spot in Super Bowl XII, had successful prostate cancer surgery at CU and was looking around the CU complex when he ran into Vogl and told him he wanted to help spread the word about depression.
Dilts, whose sister and mother-in-law both committed suicide, already had done some public speaking about prostate cancer awareness.
As one of only slightly more than 4,000 men in the world who have played in a Super Bowl and a member of that historic Broncos team, Dilts brings a guy-centric cachet to events.
When you say Bucky Dilts the former Bronco is going to attend, all of a sudden people show up and listen, said Vogl.
Dilts, who has lived in the Denver area since his career ended and works in commercial real estate, wants to remove the stigma of talking about depression among men.
Men have this old-time feeling that I can deal with it. They dont want to seek help, its weakness. Well, all that crap has to stop. If we can go out and change or get rid of that stigma its going to be a very normal conversation. Everybody talks about cancer today, even prostate cancer.
What Ive found in most cases is that Ill make a comment about why Im interested in it. I tell people the statistics, about suicide prevention, things being done through the university and around the country but in most cases you dont get anything back. They dont want to talk about it even if its a problem. There are still a lot of people who look at you like those are off-limits.
When former NFL star Junior Seau took his life, Vogl and Dilts made appearances on Denver sports talk radio stations.
Thats our audience, those are our people, said Vogl.
Dilts said the focus on concussions as a possible contributing factor in these deaths obscures the role of mental health.
Ex-NFL players suffering from depression is a bigger deal than you know about, he said.
After Denver Broncos wide receiver Kenny McKinley committed suicide in 2010, Denver Post sports columnist Woody Paige wrote of his own struggle with depression, including his plan to take his own life eight years earlier.
Woody told me he got more response to that column than anything hed ever written, said Vogl.
Boys urged to be tough
Socialization from infancy plays a significant role in how men deal with mental health issues, said Dr. Neil Weiner, director of mens studies and treatment programs for the Depression Center and a clinical instructor in the Department of Psychiatry.
When you look at the research, up until six months of age in terms of facial expression and crying, boys tend to be more emotionally expressive than girls. Once socialization starts to kick in, the pattern starts to change. If boys arent competitive or if they cry, show sensitivity or vulnerability, they are often teased, taunted or bullied, he said.
Many boys are told its not masculine to show emotions. Often emotions are suppressed, especially in boys who were raised by fathers whose male gender role expectations were molded in the two decades after World War II.
As a result, many men require a different therapeutic approach than women.
The expectation of some therapists is that from the first session, men should be encouraged to speak about their feelings. However, men raised with stereotypic male gender role expectations may be put off or leave treatment as they have been led to believe it is unmanly to discuss their feelings. They also may not have learned to use language to express their vulnerable feelings or emotions. Men may become defensive, angry or competitive with the therapist, fearing that they will appear weak, vulnerable or subject to shame or humiliation, said Weiner.
When questioned about what he is feeling, a man may be aware of feeling uncomfortable or anxious, but he may not be able to identify that hes feeling sad, vulnerable or experiencing emotional pain, he said. As a therapist, you often have to spend time helping a man identify what he is feeling and teach him to put words to more vulnerable emotions.
Weiner said that when dealing with men, he uses humor, coaching and business analogies and emphasizes how much strength it takes to come forward and seek help.
Data show that women have a higher incidence of depression, about a 21 percent lifetime prevalence compared to 12.7 percent for men, Weiner said. But when you look at completed suicides its a 7-1 ratio men to women.
Colorados suicide rate ranks sixth nationally according to the states suicide prevention office, and 44 percent of all Colorado suicides occur among men ages 25 to 54. Women attempt suicide more often, but men use more lethal methods.
Weiner said the literature shows that depressed men are more likely to present with symptoms of anger and irritability and are more likely to self-medicate. They may also get involved in risk-seeking behaviors to quell feelings of depression: fast cars, high endorphin sports such as extreme skiing, rock climbing, distance runs; or increased sexual activity.
Participating in these activities distracts them from their depression and the endorphin rush may transiently improve their mood, he said.
Women play key roles
Men often wont seek therapy until the women in their lives insist.
Their wives or mothers will tell me, Hes not who he used to be. Im scared for him. He refused to call and seek help on his own, but once I put my foot down and arranged the appointment for him, he reluctantly agreed to come, said Weiner. We see this happen all the time.
A man needs to be assured by the therapist that, if treated, his job performance will improve, he will be a better husband to his wife and the best father that he can be for his children.
Once men get into treatment, the challenge is to keep them there.
As soon as they see things are slightly better theyre more likely to drop out of treatment rather than go the distance, Weiner said.
College athletes at risk
What do Division I college athletes have to be depressed about? Sheila Ridley asks rhetorically.
As the director of student athlete wellness at the University of Colorado, Ridley, a licensed clinical social worker, counsels athletes who are at the top of their game and, the perception is, on top of the world.
Most college athletes come in here as a big fish and they wind up s a guppy. Thats not what they expected it to be. Kids dont know how to conceptualize that change and thats a trigger for depression, said Ridley, one of about 60 athlete wellness directors across the nation.
Thats a trigger for depression. They dont talk about it with each other. Theres this rule that you manage your own stuff. I wish they would talk about it with each other so they would hear, Oh yeah. Me too.
Ridley sees about as many male as female athletes, but the way they present is much different.
Females will go, OK, somethings wrong. This doesnt feel like me and they seek out answers. For men its I better study harder, get up earlier. Guys say, I must be doing something wrong.
Sometimes youll see a change in their performance but often thats the last thing to be affected. They can keep that together. Thats how we miss it.
Many of the male athletes Ridley sees come in near the end of their college years when it has become apparent that they are not going to continue in their sport at the professional level.
These kids families think theyre going to the NBA or the NFL and support their families, and theres this pressure to be more than they are. Its a hard thing to tell your mom you dont have what it takes, said Ridley.
Thats why outreach programs like mantherapy.org are getting more attention.
Joe Conrad, founder and CEO of Cactus, said mantherapy.org, like all good communication, is designed to befriend the viewer, get them to lean in, to want to learn more, to care. After youve accomplished that theyre more open to receiving your message.
Kroenke Sports, which owns the Denver Nuggets, Colorado Avalanche, Colorado Rapids and Colorado Mammoth as well as the Altitude Sports cable TV channel, is among the promotional partners.
Were hoping it continues to grow virally. Were hoping other states implement it on the ground and hope the military comes to the table and helps us further extend the breadth and reach of it, said Conrad. We think weve created something thats culturally interesting and entertaining. Who knows where it might go?