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.
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
“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
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.