The COVID pandemic has raised awareness of mental health symptoms. Yet there is still a certain stigma attached to the subject. That stigma can make it particularly tough for men in our society, many of whom have been conditioned to believe they should be stoic and solve their problems by themselves. Experts say that cases of anxiety and depression among men of all ages often go unreported and untreated.
In a recent episode of Baptist Health’s Resource Live program, host, Jonathan Fialkow, M.D. focused a spotlight on men’s mental health and how to reach out to men in your life who may be going through mental health challenges.
Guests:
The COVID pandemic has raised awareness of mental health symptoms. Yet there is still a certain stigma attached to the subject. That stigma can make it particularly tough for men in our society, many of whom have been conditioned to believe they should be stoic and solve their problems by themselves. Experts say that cases of anxiety and depression among men of all ages often go unreported and untreated.
In a recent episode of Baptist Health’s Resource Live program, host, Jonathan Fialkow, M.D. focused a spotlight on men’s mental health and how to reach out to men in your life who may be going through mental health challenges.
Guests:
Announcer:
At Baptist Health South Florida, it's our mission to care for you when you're injured or sick, and help you stay healthy and fit. Welcome to the Baptist Health Talk Podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.
Dr. Fialkow: Welcome Baptist HealthTalk podcast listeners. I’m your host, Dr. Jonathan Fialkow, I am a preventative cardiologist and lipidologist at Baptist Health’s Miami Cardiac & Vascular Institute, where I am also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health.
The COVID pandemic has raised awareness of mental health symptoms, with millions of Americans of all ages, races and genders report that they’re experiencing feelings of depression, anxiety, loneliness and loss. Yet there is still a certain stigma attached to the subject. That stigma can make it particularly tough for men in our society, many of whom have been conditioned to believe they should be stoic and solve their problems by themselves. Experts say that cases of anxiety and depression among men of all ages often go unreported and untreated.
In a recent episode of Baptist Health’s Resource Live program, we focused a spotlight on men’s mental health with two experts on the subject. My guests were:
· Dr. Rafael Rivas-Vazques, a neuropsychologist at Baptist Health.
· And Dr. Kevin Wandler, Chief Medical Officer at Advanced Recovery Systems.
Let’s hear what they had to say….
Dr. Fialkow: So Rafael, let's start with you. There's a common phrase that says, "Men are from Mars and women are from Venus." Can you dive into that a little bit? What are the differences in men and women and how they may deal with mental illness? Are there different kinds of mental illnesses and how they may present between men and women?
Dr. Rivas-Vazques: Yeah, well, I think John Gray was certainly onto something, having sold, I think, over 15 million books. And I think that it speaks to essential differences, and just wanna say that it's probably not due to any one thing, we're probably looking at a confluence of neurobiology, anthropology, sociocultural issues that have resulted in what we see as the endgame of basic differences in how men and women deal with emotionally laden stimuli and deal with their own mental health issues. And I also wanna say that we're talking in generalities. Certainly there are men who are emotive creatures and are in touch with emotionality and are able to discuss things, and there are women that tend to be more stoic and not as emotionally present or expressive. But I think when we step back kind of statistically and look at the large groups, we can make some kind of generalized statements, based on just what the science is. So we certainly know that when you look at the two most common mental health presentations, depression and anxiety, they are expressed up to two times more frequently in women than in men. So is that an actual difference? Is some of that reporting artifacts of just women are more willing to discuss their depression? When they're part of these large epidemiological studies, they're more willing to admit their anxiety, their sadness, their apathy? Possibly. But the numbers are pretty staggering and we're already, I think, on our third large epidemiological study over the past four decades that have showed the same recurring finding.
Dr. Fialkow: So Rafael, do you find in your practice and your colleagues when a man presents with asking for help, are they usually coming in on their own volition, or is there someone else that prompted them to seek help?
Dr. Rivas-Vazques: Probably a little bit of both, and the presentations are a little different. I think women tend to wanna come in, prompted on, you know, on their own accord. There are a group of men what would not be in front of- A group, not everyone, that would not be in front of us if not for the behest of someone he's in a relationship with and has asked them to come in and get evaluated and treated.
Dr. Fialkow: So Kevin, let's elaborate on that a little bit, I think that's an interesting point. When someone is around someone who seems always happy, we tend to assume that they are mentally in a good place and they don't have any issues. Is that always the case and if it's not the case, what will one see in someone else? What would someone see in a man, whether it's their spouse, a loved one, a coworker, that might be signs of that person struggling a little bit or having some mental health-related concerns?
Dr. Wandler: Yeah, great question. Definitely people that are smiling all the time aren't happy, all of them, some are, you know. I think where you see it, people have like a work face, so they may be always "happy" at work, when they go home, that's where the truth comes out. So like Dr. Rivas-Vazquez said, you know, someone in their circle may be noticing their behavior changes. And so for men especially, you know they don't come up and say "I'm losing it", "I'm depressed", they may present with irritability, anger, just going off with very low frustration tolerance. Certainly they lose interest in work or hobbies, you know if they used to go fishing, or whatever, stop doing that. Start blaming people, you know, it's projection, blaming everyone around them for all the problems in the world, or that are in their world, that is. And certainly with COVID, you know, it really became quite an issue, it still is an issue. They would be maybe more likely to go in and see a medical doctor, not a psychiatrist but a physician, cardiologist, chest pain, racing heart, headaches, digestive issues. And my other world, I'm a psychiatrist, but I'm also addiction medicine, is certainly drinking like quadruple during COVID, as a way to cope with some of the stress. They identify anxiety and depression differently. It's irritability, it's can't sleep, and so alcohol they may turn to, or certainly other drugs of use and misuse.
Dr. Fialkow: Picking up on those great points, you mentioned a little bit, and I'm reading into it. Is it a change in personality, a change in, you know, do you pick it up mostly when you know someone well, and you start seeing more irritable, a difference in their behavior, a difference in their personality, is that something that triggers a little bit, the signs that someone might be struggling?
Dr. Wandler: Definitely. At the workplace or at home. I mean, if Johnny's always irritable and nasty, that's his baseline, you know. However, if he's the nicest person to work with, say, or a great partner, spouse, father, brother, whatever, and you suddenly see these changes, they can be signs of both depression or a substance use disorder, I mean, the two are hand in hand there, great question.
Dr. Fialkow: Rafael, so following up on that, depression, anxiety seem to be the most common, confirm that if that's the case, I think you mentioned that at the beginning. What are some of the other mental health conditions that men can develop and present with that we would wanna be on alert to identify?
Dr. Rivas-Vazques: Right, so, and I think the point was well made that while depression and anxiety, as the two most common conditions, tend to be expressed more frequently in women. Men are going to express more substance use issues, are going to express more impulse control, more aggressivity, more externalizing behaviors. And those are things that we need to watch out for. Cases in which there's been a behavior change, cases in which substance abuse has gone up, and again, we just need to make sure that we're monitoring folks, colleagues, our patients looking for openings to intervene. And, remember that, going back to kind of neurobiology and anthropology, that there are structural and there are functional differences. We're wired a little differently, there are hormonal differences that are going to determine how men and women deal with conflict, and deal with emotional arousal. So, we're just not well-equipped, it's the more evolved male that has access. Remember, dealing with emotional things, and being able to talk about it, which we place a tremendous premium on being able to talk, and express our distress. It's a two phase issue. One is, I need to be able to talk about it, but before that, I need to be able to experience it. I need to have that access to internal emotional life, to be in touch with it and then talk about it. And a lot of men just shut things down. Our neurobiology is such that if we can't solve it in the moment, if we can't deal with it right away, let's shut it down, let's not let it get in the way of what we're doing.
Dr. Fialkow: It's fascinating, again, the neurobiology, the chemical makeup of men and women actually contribute to the differences. I want to get to some societal stigmas in a second back with you, Rafael. But first, Kevin, again, you've both mentioned a couple of times, men and women can express those mental health symptoms differently. Let's go back to that a little bit and make sure the viewers can see that. How do women generally present when they have a significant depression, and what do men generally present with? You guys brought it up and touched on it, but let's speak specifically to that. What would be the more common presenting symptoms with a woman versus a man with these types of mental health issues?
Dr. Wandler: Yeah so women generally will come in saying they're depressed, looking sad, disheartened, expressing worthlessness, problems keeping up with their job, whatever that is, or their duties. They may be a full-time stay at home mom, they may have a job outside of the home, and they start blaming themselves for, you know, why things aren't going well. And they can also experience drug and alcohol use as a way of coping, big time, big time. And they'll go to the, they would go to a psychiatrist or a private care physician, and ask for something to help cope with sleep and anxiety and depression. Primary care providers prescribe more antidepressants than psychiatrists, because there's more of them, and there's more access to them. For a male, again, it's, we talked about it, it's irritable, it's anger, it's acting out physically, and certainly drugs and alcohol can contribute to that. But I do want to say something, both men and women have a common theme for contributors to mental health. Certainly many have a family history, or genetics, very important, or we see a history of bipolar, we see a history of depression, anxiety, and alcohol use and substance use. Certainly, many of my patients have had history of physical or sexual abuse, which can totally change how they see the world, and how they cope with stress. A lot of history with bullying, especially in young people, we see suicides from that. Loss of a loved one of course. And then during COVID, many people lost their jobs, at least temporarily, and if you're a breadwinner, I mean that's a huge blow, to either male or female, I mean whoever the breadwinner is, you've got to support your family. And of course, drugs and alcohol problems, I see them hand-in-hand.
Dr. Fialkow: So, certainly in the cardiovascular realm, it's well established that women tend to ignore their problems, seek help later, for various reasons; having to care for the family, worrying about the spouse more. Rafael, you mentioned, there's some biochemical differences, "men are from Mars, women are from Venus", what about some societal concerns, or the stigmas that may attach to a man seeking help for this area, do you see that, do you find that there's a stigma attached with a man complaining, or recognizing they have some mental health issues and needs, and if so, why do you think that's the case?
Dr. Rivas-Vazques: Yeah, it always comes back to three things; weakness, weakness, weakness. Men are perceived as being weak if they seek help. How often there's a certain amount of shame when a man sits in front of you to admit that he feels depressed, apathetic, maybe socially impotent in the sense that we saw this over the past year, with loss of job, loss of income, where men truly felt impotent, and unable to bring about change, and provide for the family. And there's a certain amount of shame, not only that they're going through it, but now I'm sitting in front of someone having to discuss it. It almost reifies the pain they're going through. And women seem to find truth, genuine relief in connecting, in that dyadic sense of I'm talking with someone, I'm receiving empathy from them. I've sat with men, where, they almost feel embarrassed that the empathy that you're showing them makes them feel good, right? "I should be able to do this by myself", how many euphemistic phrases do we have? "Pull yourself up by the bootstraps", "it is what it is", what does that mean, "accept reality, dampen out your feelings and keep moving forward".
Dr. Fialkow: And I can echo that from experience, as a physician leader I've had to recognize these changes in some of my doctors, and sat with them at this level, and at first, there might be a little discomfort on their part, but then, they'll open up, we can make them better, so I certainly echo that. Going back to the COVID comments you guys made, Kevin, do you think, or have you guys, I'll ask both of you, but I'll start with Kevin. Has COVID made it easier for men to open up about these stresses? We know the stress, the anxiety, the work-related, financial, the being closed in, the uncertainty of the pandemic, family issues, all the things that we can recognize can increase these; stress, anxiety, depression, substance abuse, do you find the pandemic has made it easier for men to recognize it and seek help, or have you not really seen any kind of shifts in referrals and requests from your guys' services?
Dr. Wandler: Well, as has been discussed, there's been a lot more, well I guess I haven't discussed, there's been more depression and more anxiety since COVID hit. And so we may be seeing more men and/or women because of that. However, as soon as the pandemic hit, many resources disappeared, you know, mental health counselor's offices closed, psychiatry offices closed, and we went to something magical called Telehealth, suddenly it's everywhere, and that's a good thing. If anything good came out of this, that might be it, and ensurers are looking at reimbursing for Telehealth sessions. And so there's a group of individuals we see, and especially young, younger, and how do you define "younger" I guess is a relative term, but younger people really kind of like the Telehealth part. They can sit in their room, at home, do a session with a doctor, or a therapist or a counselor, and not have to worry about getting COVID, and this is especially before the vaccine came out, and actually get some care. Then there's a group of people that don't want to do this "Tele-stuff", you know? And "its not real therapy", and there's others that find it easier to talk because, you know, I'm not in their space, you know, so to speak, I am, especially me, I am 2,000 miles away, or whatever. Anyhow, so it's a double edged blade, so I'm not sure if it's actually gone up.
Dr. Fialkow: So we've created an environment where we can identify an increased drivers of mental health issues, as we've decreased access, and now the telemedicine, the Telehealth components, might be resolving, or at least providing that access back. Do you guys see, and I'll as you first, Kevin, quickly and then Rafael, do you see a generational shift? For example, is the younger generation more open, less open, the same towards, I'm talking about the men, towards seeking help or identifying their own needs? Do you see any generational differences? And we'll start with Kevin, quickly.
Dr. Wandler: Definitely do, I think younger people are much more willing to talk about their issues, it even goes to teenagers, everything I said earlier about triggers for mental health and substance use, is the same for kids. They are, they get a lot of exposure to mental health because of suicides, and the scary things that have been out there with you know, the shootings and et cetera. And so younger people are getting more used to it, I think that the millennials, I have a couple at home, or they're grown up now but, they talk all the time. About everything, I mean, and not because I'm a psychiatrist and I'm their dad, I mean they talk to everybody about everything.
Dr. Fialkow: More expressive.
Dr. Wandler: More expressive. 65 year old plus, not so much. And they're at really high risk, again, that maybe now are no longer working because of just aged out or aren't able to, get depressed, they may have lost their partner, if they had one, or spouse, family is distant, et cetera, et cetera, are really high risk. And if you have an elderly male, well anyone for that matter, who's talking about suicidal ideation, those guys will do it. You know? They'll follow through.
Dr. Fialkow: Why do men, why are men more likely to die by suicide than women?
Dr. Fialkow: Any thoughts?
Dr. Wandler: Yeah, they use more violent means. You know, women tend to use cutting and pills, you know, and they're certainly cries for help, I'm not minimizing, and people can die from those things, but less likely to.
Dr. Fialkow: So it's not the rates of suicide are different, it's the success of suicide that's the?
Dr. Wandler: Yes. Women actually attempt suicide more than men, but men are more successful, because a gun, you know, you really, it's one and done, you know, unfortunately and hanging, et cetera, more violent means.
Dr. Fialkow: Very scary.
- Yeah.
Dr. Fialkow: So Rafael, let's switch gears, as we wrap up on a couple of points. We've identified the differences between men and women, both in how they present, and how they address their own mental health needs. Let's talk a little bit about what we can do to help people. When someone seeks help, what's the benefit of such? What does seeking help, and getting help look like?
Dr. Rivas-Vazques: You know, first and foremost, assessment regarding level of acuity, symptom severity, what's the right treatment? What's the right diagnosis, and then what's the right treatment to prevent further decline, to alleviate distress, to correct any impairment. So, again, the assessment and the prescription as to what's their appropriate treatment, always leads the way. The two primary treatment paths are medication, psychotherapy or counseling, or a combination of both. And depending on the patient, you individualize that plan to make that determination. But clearly there is tremendous health benefits to be able to come in, get the correct assessment and get the adequate treatment initiated to restore functioning and alleviate distress.
Dr. Fialkow: I think that's well said, it's the customization. You can go online and read stuff, but the clinical assessment is your particular circumstances, your needs, your benefits, your treatments, so we want to encourage that. Do you find when someone seeks help, that that means they will be on medications or treatments for the rest of their life, is that a guarantee?
Dr. Rivas-Vazques: Not necessarily. I can defer to Dr. Wandler on this, as a psychiatrist but, not everyone that comes in, first and foremost, is gonna need medication. And then of those patients, within which it's indicated for medication, depending on the degree of, the duration of illness they've had, if they've had prior episodes of depression or anxiety, that's gonna dictate how long they're going to be on treatment. And again, not everyone needs medication, and not everyone benefits from psychotherapy necessarily, there's some folks who aren't kind of, wired that way, and that's that customization of who's gonna benefit from which modality, either monotherapy or combination.
Dr. Wandler: Most depression that I've worked with is cyclic, or once, you know, we have like the COVID pandemic. Many people are actually having post-traumatic stress disorder from this, because of all the consequences of the pandemic, from isolation to distancing, to masking, to vaccinate or not to vaccinate, I mean there's a lot of issues there, and if they've had depression before, responded before to medication and therapy, and I like the combination personally, then likely they have a short-term situation. However, if they lost their job, I mean, if there's a series of social circumstances, they may be having to come in for quite some time. My goal is trying to get people off of medications in 6 to 9 months, if possible. As long as they're in therapy, also.
Dr. Fialkow: I understand. Something I think that could support our viewers, Rafael, I'll ask both of you as well. So now, you have a loved one or a coworker or a someone you're exposed to who you think is having problems, or that person may even hit rock bottom and reach out to you. How can one support a male friend who is having mental health issues?
Dr. Rivas-Vazques: Yeah, you know, the past year with COVID has given us plenty of opportunity for friends and colleagues to approach us. First, make sure that there's, in that initial interaction where they're reaching out to you, that there's supported reinforcement of how important it has been for them to reach out to you, share a little bit of your own distress during this time, as a way of connecting with them, and encourage them to seek professional help. Try to destigmatize it, try to normalize it for them, and really try to encourage as much as possible. If they're not comfortable seeing a mental health professional, have them at least talk to their PCP, as also an alternative path. Getting them to see a psychiatrist or psychologist is optimal, or any mental health professional, but at the very least, once they've reached out to you, if they're not willing to do that, have them connect with their PCP.
Dr. Fialkow: And the primary care can either help them or help expedite a connection too, which is just as worthwhile as well. Kevin, what about the individual who might be recognizing or trying to determine if they need help, what would their first step be?
Dr. Wandler: Well, I think, you know, if they're having thoughts of suicide, you know, that's a big deal. And we certainly have them call something like the National Suicide Prevention Lifeline, and I think you're going to give the number, I'll give it now too, it's 800-273-8255, for support. And there's a lot of different crisis management phone places out there that people are able to access. It's all regional, so if someone's in a different state than Florida, their resources may be different. But the suicide helpline is national, and so that's really important. And then I try to encourage people, if this is a friend, you know, okay, well let's start doing some simple things, I mean for me, COVID was a time of stress, anxiety, loneliness, and so how do I deal with that? Well let's just do simple things, go to the grocery store, you know, and my poor cashiers hated seeing me because I chatted them up, it was someone live to talk to, you know? I'm married, my wife is sick of listening to me for the last year, I mean it's a whole different thing. And then those resources, if you call those helplines it will also give them more resources local in their community.
Dr. Fialkow: As we wrap up this episode, I’d like to encourage all our listeners to take a moment to give this podcast a five-star rating on whichever platform you listen to us on.
And if you have a comment or a suggestion for a future topic, we’d love to hear from you. Email us at Baptist Health Talk at baptisthealth.net. That's Baptist Health Talk at baptisthealth.net. Thanks for listening and stay safe!
Announcer: Find additional valuable health and wellness information on our resource blog at baptisthealth.net/news, and be sure to interact with us on our social media channels for live and upcoming events. This podcast is brought to you by Baptist Health South Florida. Healthcare that cares.