It’s mental health awareness week, again. I have mental health issues and I find that, when I talk about them, even if it doesn’t necessarily help me, it does help other people out there facing the same issues. I hope it also helps foster understanding, and I also hope it helps underline the problems with mental health provision in this country (the UK), and how the systems that are in place can fail men.
I know that latter part is controversial and opens me up to criticism from those who dismiss all men’s issues as misogynistic or solely the concern of ‘incels’. Nonetheless it is true that men’s mental health – in particular – is in crisis, with men continuing to commit suicide at a high rate, to be exploited by gurus like Tate, and also lashing out and causing problems in the world around them.
I hope I’ve found a healthier way to exist and endure, and I hope my experiences and openness helps someone.
I HAVE
I have clinical depression and while I was first diagnosed in 2007 it seems likely I had depressive issues going back much earlier, with a couple of bouts triggered by life events (such as relationship break-ups) previously requiring medication in the short term. This depression, however, is not connected to any particular event, it happens for no reason on an irregular but recurrent basis.
I also have anxiety, particularly around social contact and especially when dealing with ‘authority’ figures such as utilities, banks, government offices – even something so simple as paying for things at the till in a shop.
I have, previously, been on antipsychotics for a time, to address intrusive thoughts related to my depression, suicidal ideation and self-harm. I was not psychotic or skitzophrenic, but those urges and ‘voices’ were so loud as to require supplementary medication.
I now also have certain physical issues as well, related to ruinously high blood pressure, but everything is somewhat interrelated.
WHAT IT’S LIKE
Depression is hard to describe and hard to get people to understand. It also manifests differently for different people.
For me it typically manifests as unshakable exhaustion and a total collapse of motivation. It is far more than just being ‘sad’, it carries the same weight as grief, but it doesn’t fade over time with acceptance the way grief does. Grief is a useful comparison because it is a crushing sadness you can’t really do anything about, what is lost is lost and nothing you can do will make a difference to that.
Depression can also carry physical symptoms with it, leaden limbs, physical aches in the muscles and joints. It can hit you like the flu, minus the mucous and fever.
Anxiety, for me, manifests as a fight or flight response – panic – to situations and issues that shouldn’t provide such a panic. It makes me avoidant of social situations where there’s any capacity to avoid socialising. While it’s primarily social anxiety, I also get helplessly panicked about travelling, driving and many other situations.
My heart hammers, I tremble, my legs get weak, my hands shake, I feel faint and I want to run away and hide. Again, this is a completely disproportionate response to normal events, but it’s something I have no real control over, and struggling on through is tiring in the extreme.
‘Masking’ is something a lot of people with mental health issues do, this is basically put, pretending to be OK. It takes a huge amount of effort, and can get us past the issue in the moment, but comes with a ‘hangover’ of even worse tiredness, or even worse symptoms, when you can finally relax. Sometimes you can even get ‘stuck’ masking, unable to express the emotions and distress that you really need to.
Masking can also make people think you’re fine, you get very adept at lying, when you’re not, and can contribute to suspicion and prejudice against people with mental health issues (and other invisible illnesses) even more than acting distressed in public.
THERAPY & DRUGS
I’ve been through the UK’s mental health system and I do not believe that it is fit for purpose. It’s easy enough to get onto drugs to flatten out and reduce the impact of your issues, but general practitioners are normally not especially skilled when it comes to mental health issues and provided you are ‘coping’ (on the drugs) there isn’t a great deal of interest or urgency in further helping you.
If you become suicidal, as I have been in the past, then something more might get unlocked for you. You may be permitted to access the Community Mental Health Team, where you might get to see a therapist every week or other week, and after several months you might get a short appointment with a proper psychologist.
Unfortunately the only care that seems to be available is talk therapy and Cognitive Behaviour Therapy. A one-size-fits-all approach to a collection of very different illnesses that require more individuated care.
The problem with this approach is that the National Health Service runs on a triage system – and quite understandably. Mental health issues are long term, costly to deal with, and do not really have any sort of ‘cure’, making the cost/benefit analysis brutally slanted against investing more in it.
This is where the gendered issue also comes in. This emphasis on CBT and talk therapy better suits women than men. The short appointments harm men, who need longer to ‘open up’ and address their problems. These forms of therapy are known to be less effective for men, but they’re all that’s available unless you can find a self-funding group or can afford private care.
If it wasn’t helping me, why would I keep going, using up a slot in a stretched service that could be helping someone else?
The drugs have their own side effects and issues. They can make you extremely sleepy and ‘zombified’, they can cause nightmares and night terrors, can make you feel worse in the short term – which is less helpful in emergency situations. Some antidepressants can flatten your emotions so much that you can no longer cry, even when you might need to or it might be appropriate, or can become a bit of a ‘robot’. Some can affect your libido, either making you unbearably horny all the time, or unbearably sexless, uninterested, anhedonic and even unable to orgasm or even get aroused.
Yes, being unbearably horny all the time is just as bad, in its own way, as its opposite.
BEING PATRONISED & BEING IGNORED OR SUSPECTED
Our culture and political environment at the moment seem to embody the worst of both worlds.
On one hand you have the ‘right on’ activists and so on who will fight ‘for you’, eclipsing your actual beliefs and needs with the ones they project upon you. They will uselessly fight for ‘representation’ you don’t give a toss about, while being absent when you want to campaign for public understanding or more money for mental health services. These same people who claim to care so passionately about you and your problems, will ignore you and your disability if you disagree with them in the slightest.
On the other hand there are people who think mental health problems aren’t real and that you just need to change your mindset or go to the gym more. There are also those in this group who think you are faking it unless you’re missing a leg, or if you can mask well. Those who want to take away the scant provisions and benefits you do get because they believe you to be ‘scrounging’.
Somehow we have conspired to create a sociopolitical environment that manifests the very worst aspects of both ‘left’ and right-wing attitudes when it comes to marginalised and suffering people.
HOW TO FIX IT
You can’t, really, the will to do so isn’t there and those who could advocate for change and investment are too busy insisting that documentaries about feudal Japan cast a wheelchair-bound Peruvian as the Shogun. Social change is difficult, and both political wings don’t seem interested in doing what’s needed, only superimposing their own ideologies on the issue.
If you were to try and make things better it would take money, and spending money is never popular with British governments, especially in an already cash-strapped NHS.
You would give additional training for General Practitioners.
You would increase the number of Community Mental Health Teams.
You would increase the number of psychiatrists in the NHS and available to CMHT.
You would increase the number, and variety of therapists on the NHS, or create a voucher scheme to allow those unresponsive to CBT to seek out other more effective therapies at a discounted rate.
Men’s appointments would be longer, to allow the additional time to get comfortable and to open up.
Home visits would be available for those with extreme anxiety or agoraphobia.
None of this is likely to happen, but perhaps in putting it out there it will have some effect.