In the second of his editorials looking at the challenges ahead in European men's mental health,
Dr Wolfgang Rutz argues against a unilateral approach to health promotion otherwise the sort of antisocial behaviour that is seen as a male problem today will be seen as a female one tomorrow.
Recent WHO figures suggest male suicides will continue to increase, widening the gap between male and female suicide figures, but also point to an increasing morbidity and mortality linked to personality disorders, alcohol and addiction, depression and depression-related conditions as well as anxiety states. Morbidity and mortality patterns in south-eastern European countries after war and internal conflicts support these findings.
From an international perspective two paradoxes of public health should be mentioned.
The first paradox is that men seem to be depressed much less frequently than women, yet commit suicide three to nine times more often. This is despite of the fact that there is considerable evidence that in most cases depression and suicide specifically and causally are linked to each other. The other paradox is that female morbidity is so much higher than male one, but that male life expectancy is so much shorter.
An explanation could be the male’s incapacity to show weakness and ask for help in time, resulting in self neglect and a tendency to medicate themselves in states of helplessness and despair, by alcohol, addiction or other types of antidepressive behaviour such as gambling, risk taking or excessive physical exercise or work, able to implode in self-destructive suicidality or to explode in violence, impulsivity, aggression and psychopathy, in a way which characterises so clearly many helpless, formerly nicely adjusted and socially competent males.
What could be done?
In the past gender ersearch was understandably directed towards women. However, in the light of recent European mortality and morbidity figures in times of transition and societal stress – and there is no reason to believe that this stress will decrease in a near future - an awareness of the need of balancing gender approaches and health preventive and promotional activities is becoming apparent.
Women’s and men’s quality of life has a common denominator. Non-treated male mental ill health leads not only to individual suffering and death but also to family violence, aggression, war and disaster, to social degradation and isolation afflicting familiar and societal cohesion, economic resources and well-being, for both females and males.
We know today, that an adequate recognition, treatment and monitoring of depressive conditions decreases suicide mortality and probably also depression related co-morbidity such as cardiovascular and cerebrovascular diseases. There are good reasons to believe that even depression-related aggression and violence would diminish.
The problem is that especially males don’t seek help, and if they do they don’t get it because of inadequte diagnosis or because of being rejected on the grounds of symptoms of aggression, acting out and addiction, or their lack of compliance.
Better diagnostic criteria are needed as well as early intervention, following screening activities - in working places and elsewhere. Services should be offered which facilitate men’s compliance. In society, awareness, sensitisation and anti stigma approaches are needed – good examples can already be found today.
WHO’s task is not only to focus on disorder, disease and death, but also to focus on positive factors, to find them, to analyse them and to utilize them.
We need to find out what is protecting females in times of change and transition, what gives them the strength to show weakness and seek for help in time, what is the basis for their better capacity to keep socially connected, to cope with stress and losses and to find meaning in life, to be in charge and to keep control both psychologically, existentially and practically. Cognitive therapeutic methods focussing on increasing male help-seeking ability and compliance have been discussed and tested.
Unrealistic male self imaginations supported by social role expectations of men as always being strong, warriors, defenders and family providers, generated in traditional but to day outdated societies, could be a focus. Re-designed services, especially mental health services are needed, not only available but also acceptable to males.
However, in gender directed activities a unilateral focus on men’s needs following a time of a unilateral focus on woman’s needs, would be the wrong answer. Given the suffering which men’s and women’s ill health causes interactively in both genders, approaches commonly directed to both men and women should be more utilized again.
The kind of mental ill health related morbidity and mortality described above has, until now, predominantly afflicted males. But today it can increasingly can be found in female populations. Among younger women in some of the Scandinavian countries, for example, there is an increase of alcohol, addiction and aggression, stress related morbidity and mortality, and an increase of destructive lifestyle and behaviour patterns including suicidality leading in some countries to a first time decrease in life expectancy in women. Here, much more research is needed.
Solutions can in the long run certainly not be found in only one gender directed activities. Both genders would profit from a more comprehensive and balanced approach. Raising awareness about the problems which exist, the balance to be created, and the amount of knowledge, capacity and ability each gender has to acquire from and about each other could be one of the first steps.
Dr Wolfgang Rutz, MD, PhD is Regional Adviser for Mental Health
in the World Health Organisation Regional Office for Europe.
Starting soon: a series of editorials from various countries around Europe. The perfect follow-up to the EMHF's study into The State of Men’s Health in 17 Different European Countries
Related links:
World Health Organisation
World Health Organisation (Europe)
