He continued off and on for about 10 years, treating therapy, he says, like a gym workout for his mind. It was helpful, to a point. “There was this whole idea that an epiphany was going to happen, and all of a sudden whatever was lurking in the back of my mind that was making me anxious would be released and then I would be cured.” That never really happened.
More recently, he decided to try cognitive behavioural therapy, in which a therapist guides a patient through strategies to deal with his problem; he went for several months, and found he preferred it. He learned to see his physiological responses to anxiety as temporary, and understood more clearly why alcohol or tranquillizers only masked the symptoms, without alleviating them.
“I felt like there were techniques being taught that I could use to cope, in a practical way,” he says.
Robert is not alone. Men who attend therapy report satisfaction levels similar to women, but studies have found that they may respond better to certain approaches. John Ogrodniczuk, director of the psychotherapy program at the University of British Columbia, says his research has found that men-only groups are popular and effective; when men are put in mixed groups, where they are often outnumbered by women, their active participation drops significantly.
The men in Dr. Ogrodniczuk’s studies responded best to short-term, individual therapy that focused on practical solutions as opposed to supportive therapy that reassures or sympathizes with the patients. The opposite was true for women.
As well, interviews with men dealing with mental-health issues have found that they valued therapy well above medication. They reported that taking drugs made them feel powerless to help themselves, whereas therapy was a form of self-management, says John Oliffe, an associate professor at the School of Nursing at the University of British Columbia who specializes in men’s health.
Other research has found that men appreciate the reciprocal nature of a group – the sense that they are actively helping others, a strategy employed in Alcoholic Anonymous, which gets more male participants than women.
Australia has responded to this pattern by developing a network of neighbourhood “sheds” (garages) that serve as physical spaces for men to meet. In Britain, public awareness campaigns have targeted players and spectators at soccer games.
But even the messaging in those campaigns, Dr. Oliffe suggests, has inadvertently fostered stereotypes. While men do visit the doctor less often than women, he says, emphasizing this statistic may make men less likely to change this habit.
Men tend to seek medical attention in emergency rooms, which are not designed for long-term evaluation and care, especially for mental-health issues.
Some gender patterns in mental health are well known – for instance, males are more likely to be diagnosed with schizophrenia. But there is currently a debate over whether to recognize a disorder of “male depressive syndrome.” And Dr. Johnson, among others, proposes that all diagnostic categories should be studied for gender differences.
Women are diagnosed for depression and anxiety at far greater rates than men. Researchers are not sure how much this is due to biology, gender expectations or overlooking male cases.
But the male suicide rate, which is four times higher than the female, clearly suggests something is wrong, Dr. Oliffe said. “We are missing them, and then the point we pick them up is in the judicial system, or in addictions treatment.”
Many people seeking help for mental-health issues have difficulty getting proper diagnoses, and the men in Dr. Oliffe’s studies reported being turned away about three times before help is offered – a major deterrent for already-ambivalent patients.
Because men tend to report feeling “stressed” more than “sad,” family physicians prescribe rest instead of therapy. Even nationwide surveys on mental health pose questions in a way that might leave male depression underreported – Dr. Johnson points to one that asks people if they cry frequently.