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FirstHealth of the Carolinas
Boys to men By Christine Cardellino
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A 50-year-old manufacturing supervisor argues violently with his family after losing his job due to layoffs.

A teenage boy gradually stops socializing with friends and withdraws from family outings he once enjoyed.

A 27-year-old store manager develops stomach problems and headaches after the breakup of his marriage.

Pressures of adolescence, decisions of early adulthood, soul searching at midlife and emptiness at retirement are stages that all men face throughout their lifetimes.

And although most boys and men will navigate their way with few mishaps, some will be afflicted with depression, anxiety, substance abuse or severe mental illness.

The National Alliance on Mental Illness defines mental illness as “medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning.” Ten percent to 15 percent of Americans live with a mental illness. And because of society’s stigma associated with behavioral health problems, many people are reluctant to get treatment or ask for help.

That’s even truer for males, who, as young boys, are taught to be strong, clear-headed, and non-emotional—and men typically don’t like to go to the doctor.

“If a young man broke his leg, he would not hesitate to seek medical treatment,” says Scott M. Klenzak, M.D., a psychiatrist with Pine Cone Clinic in Southern Pines and the Sandhills Center for Mental Health. “But, in most cases, if this same man was feeling depressed, tired all the time, or even suicidal, he would be unwilling to talk about his feelings and seek medical help. If left untreated, however, mental illness can lead to personal, family and financial difficulties, or worse. But with appropriate diagnosis and treatment, many men will feel better and live fully functioning, rewarding lives.”


Scott M. Klenzack, M.D.


David C. Ruck, M.D.


George D. Bussey, M.D.

Adolescent angst
It’s characteristic of teenagers to occasionally be moody or depressed for a few days, “but when teenage boys isolate themselves from their friends or family, lose interest in activities, stop going to school, lose their part-time job, or if their grades start to drop, parents should be concerned,” says Dr. Klenzak. “Most of the time, parents are aware their son has a problem, but they usually are surprised by how serious it is. Unfortunately, suicidal thoughts, self-harm (such as cutting themselves) or substance abuse is not uncommon.”

“Sometimes teens come in with a mood disorder, anxiety disorder, or a destructive behavior disorder that could be a new problem but often is the worsening of a preexisting behavior,” says David C. Ruck, M.D., a psychiatrist with Carolina Behavioral Care in Pinehurst. “In many cases, parents and teens falsely believe that if they try hard enough or ignore the problem, it will go away.”

Typically, teenage boys will not ask for help and are reluctant to talk to their parents about what is bothering them. Nonetheless, parents should start by first talking to their child as well as his teachers and friends. If there is a severe dysfunction (such as failing out of school or crying all of the time), parents could start with a school counselor or their family physician.

“Not every child who is going through a hard time has a mental illness, but some do,” Dr. Klenzak says. “Depending on the severity of your child’s situation, you may be referred to specialty care such as a psychiatrist. Most important is a thorough assessment. Counseling,

changes in the family and changes at school may help. Sometimes medication can be part of the treatment.”

“I try to delay prescribing medication for teenagers unless the child is experiencing severe symptoms such as not getting out of bed, gaining or losing excessive amounts of weight, or if they are suicidal,” says Dr. Ruck. “In many cases, the combination of medication and psychotherapy is most effective. A few years ago, the FDA issued a warning that some antidepression medications for teens could make suicidal thoughts worse. I always recommend therapy with medication so the teen is more closely monitored.”

The young adult years
Previously, experts believed that brain development was completed by age 16 or 17, but today’s research shows that the brain is still undergoing changes even up to age 25 or 30. For young adult males, this means the possibility of a prolonged adolescence.

The key transition during this stage is moving from the family home to college or to their own place, and becoming self-sufficient by working and supporting themselves. For any young man, this can be a time of added stress. For some, it can be a time of depression or increased substance abuse.

The onset of severe mental illness, such as bipolar disease or schizophrenia, is usually recognized during these years.

Although men seem to have a more difficult time than women making the transition to commit to marriage and family, research shows that men are happier and healthier when they are married. Married men experience less substance abuse, depression and anxiety—but divorced men are much more likely to experience these problems.

The middle-aged man and senior years
Middle age is a time when most men reflect on their lives: What have I done with my life and what is there left to do with it?

For many men, their jobs have been a prime source of personal satisfaction and a way to define themselves in traditional masculine roles. At midlife, those who work a physically demanding job, such as a construction worker or mechanic, may have a difficult time adjusting to the fact that they are no longer able to keep up with newer, younger guys. An accomplished business executive may realize he no longer is the “young professional” who is frequently awarded exciting new assignments and promotions.

“It can be very difficult for middle-aged men when they realize they don’t have the stamina or energy to perform at work as they did when they were 25,” says George D. Bussey, M.D., a psychiatrist and the chief medical officer for FirstHealth of the Carolinas. “Or when they realize the level they have reached at the office is probably where they are going to be for the rest of their career. But coping with these normal transitions is crucial to maintaining your happiness and mental well-being.”

“This is also a time when some men become actually more adolescent and selfish,” Dr. Bussey says. “They may feel unsatisfied with their marriage and children and, in some cases, consider divorce and starting a ‘new’ life. Unfortunately, in many of these situations, men wind up becoming even less happy than they were initially.”

Extra free time during the retirement years contributes to many men’s beliefs that they have lost their identity, particularly when that identity was associated with their jobs.

“In many cases, men in their older years will look back and be critical of decisions they made or feel that their best years are over,” Dr. Bussey says. “Maintaining relationships with family, volunteering, playing golf or tennis, or enjoying a physical activity that doesn’t depend on a 30-year-old body can help older men adjust to this new stage of their life. There is still much to look forward to as you grow older.”

What is “normal” stress?
“Worry and stress are common in today’s fast-paced society, and we all feel a certain level of anxiety that is normal to experience,” Dr. Klenzak says. “However, when an individual has a severe mental illness, he may not be able to handle his anxiety, and it may stop him from going to college, getting good grades, attending work regularly or keeping his job. If anxiety, depression or substance abuse stops you from having a relationship with someone, spending time with friends, and generally interferes with your life, it is a mental illness and requires evaluation and treatment by a trained professional.”

Reducing the stress in your life and learning how to handle life’s transitions are effective ways to find balance in your life. Following are ideas for relieving stress:

All work and no play are not healthy. Take time to relax with a hobby.

Keep a regular sleep cycle.

Maintain relationships with family and friends. And keep your social networks with neighbors, coworkers, classmates, friends at church and others.

Exercise is a natural stress reducer.

Recognize that life is a series of changes and change is a normal part of everyone’s life.

Substance abuse
“We live in a culture that is very oriented toward drinking alcohol at every party, sporting event or celebration,” says Dr. Bussey, who specializes in substance abuse. “Like many psychiatric disorders, substance abuse has a significant genetic component. This is often what transforms an individual from a heavy social drinker or sometimes drug user, into an alcoholic or drug addict.

“For young men who have a vulnerability to this disease, exposure to frequent heavy drinking patterns is very dangerous and risky in terms of starting them down the path of alcohol or drug dependence.”

Although it is unlikely that a man will suddenly be faced with depression for the first time at age 50, it is possible for someone to become addicted to alcohol or drugs later in life.

“One highly genetically driven pattern of substance abuse is the early alcohol or drug-dependent person who has been exposed to alcohol or drugs in their teenage or college years and, as if a switch has been flipped on, they precede immediately into addictive or abusive behavior patterns,” says Dr. Bussey.

“Another different, but still inherited pattern is the people who are functional but are heavier-than-average social drinkers throughout their 20s, 30s and maybe even 40s. With their genetic vulnerability and lack of development of other stress-reduction techniques, they often depend on alcohol or substance abuse as a stress reducer. As they face the changes and pressures of midlife and retirement, the ‘switch’ gets flipped on and their use becomes out of control.”

The good news for any man experiencing a behavioral health issue is that treatment and recovery are possible.

“It’s important for men and the women in their lives to realize it is common to sometimes feel discouraged and down about life,” Dr. Bussey says. “But even more important is realizing that if routine life changes are causing irrational behavior or disrupting your normal life, then you should seek treatment from a qualified mental health professional.”

For more information on Behavioral Services programs offered by FirstHealth, call (800) 213-3284 toll-free.

Men + suicide
In 2004, suicide was the 11th leading cause of death in the United States and the eighth leading cause of death in men. Although more women attempt suicide each year, overwhelmingly, more men complete their suicide attempt. In fact, almost four times as many men as women die by suicide.

According to the National Institutes of Health, more than 90 percent of people who die by suicide suffer from depression and other mental disorders or have a substance- abuse problem usually in combination with other mental disorders.

“Men who are at higher suicide risk tend to have alcohol or drug problems, have isolated themselves from their social network, and have had difficulty successfully adapting to life’s transitions,” says George D. Bussey, M.D., a psychiatrist and FirstHealth’s chief medical officer. “Suicide is a preventable health crisis. Encouraging men to share their problems with somebody and to seek professional treatment is critical.”

In addition to depression and substance abuse, other risk factors for suicide include a family history of suicide, family violence including physical or sexual abuse, a prior suicide attempt, stressful life events (in combination with depression) and the presence of firearms in the home, which is the method used in the majority of suicides.

Suicide is a significant problem for teens and young adults.

“Teens are impulsive and most don’t have a sense of the serious consequences their actions may have,” says David C. Ruck, M.D., a psychiatrist with Carolina Behavioral Care. “What may be attentionseeking behavior (such as experimenting with drugs or over-the-counter medications) can be deadly. When a child has made suicidal threats or a suicide attempt, parents should bring them to the hospital as a safety precaution.”

If someone you love is threatening to harm or kill himself, do not leave him alone, particularly if he has a history of mental illness or substance abuse. Call 911 or your family doctor right away.