Men and mental illness: Suffering in silence

Brett Zachman started his organization BeMen to help men find a community where they could connect about issues including mental health.

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Jarrod Hindman helped launch Man Therapy, a campaign aimed at getting men talking about their mental health and lowering suicide rates.

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Carl Nassar founded Heart Centered Counselors in 1999.

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Jason Hopcus is president of the National Alliance on Mental Illness of Douglas/Arapahoe Counties.

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Hanging on Brett Zachman’s desk at the financial firm where he works in Littleton are BeMen flyers for the organization he founded to offer a place for men to gather and discuss issues important to them.

Jessica Gibbs

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Brett Zachman vividly remembers his first panic attack.

He was driving at 10 a.m. on a Thursday morning, not long after the woman he’d been seeing for three months ended their relationship. That Monday, he’d also signed divorce papers, the final step in an 18-month process ending his 10-year marriage with his wife, whom he’d been separated from for several months.

The latest breakup, Zachman said, became a catalyst unleashing all the emotions he suppressed during his marriage, separation and divorce.

“It felt like the hand of death reached up underneath my rib cage and squeezed my chest,” said Zachman, who lives in Parker. “I thought I was having a heart attack.”

His muscles tensed. His body slowed down. He felt an emotion that was almost painful. He began crying uncontrollably.

Zachman pulled into a gas station parking lot and flipped through his phone, searching for someone to call. Finally, he dialed his sister.

“I couldn’t even hardly speak,” he said. “I think I finally kind of broke down and said, `I don’t know what’s wrong with me.’ ”

Letting go of ‘abusive thinking’

What was wrong with Zachman was depression, a mental health condition affecting more than 6 million men in the U.S. each year, according to the National Institute of Mental Health.

Anxiety and bipolar disorder, along with psychosis, schizophrenia and eating disorders are among other common illnesses affecting men, the national advocacy organization Mental Health America says.

But unlike women, who studies show are more likely to receive treatment for mental illness, men often are hesitant to ask for help because of social norms, a reluctance to talk and a tendency to downplay symptoms, according to mental health experts and organizations.

Those factors, taken together with a rising rate of suicide among men — it is the seventh-leading cause of death among males, according to the Centers for Disease Control and Prevention (CDC) — have spurred many researchers to describe the state of mental health among men as “a silent crisis,” stated Rob Whitley, an associate professor in the Department of Psychiatry at McGill University, in the publication Psychology Today in February 2017. 

“A lot of men are out there suffering in high proportions and it’s silent because it’s rarely talked about,” Whitley said to Colorado Community Media. The crisis, he said, is a global one: Between 70 percent and 80 percent of suicide deaths in most countries throughout the world are men, and men account for about 75 percent of substance abuse disorders.

The stigma associated with mental illness, along with barriers of cost and accessiblity to resources, impede the majority of people living with a mental illness from getting the care they need, medical professionals and research shows.

Among men, the greatest barrier may be stigma, say several men interviewed for this story and mental health professionals. The fear of being considered weak, of not measuring up to traditional expectations of masculinity, contribute to staying silent about any mental health challenges.

“Strength, weakness are basic concepts coded into every guy’s inner language,” said Hal Knight, a father in Centennial diagnosed with bipolar disorder, who has attended support group meetings in Highlands Ranch. “If something beats you, then you’re weak. If you’re depressed and can’t get out of bed, your male brain will tell you that you’re weak, you’re lazy, that you’re not strong enough to be a good father or husband.”

It took him years, Knight said, to “let go of that abusive thinking.”

In Douglas County, where the median household income is $109,292 and the population is generally highly educated, high expectations about being successful and providing for your family put additional pressure on men, said Jason Hopcus, president of the National Alliance on Mental Illness for Douglas/Arapahoe Counties.

“Not all of Douglas County,” Hopcus said. “But there are some segments of it that are a little like `keeping up with the Joneses,’ and there’s a lot of pressure with that.”

The negative cultural effects arising from that stress can exacerbate or lead to depression, anxiety, substance use and abuse, and a lack of connection within a person’s family, personal or professional life, Hopcus said.

“I think the effects are kind of endless,” he said.

Whitley said in his studies men also reported feeling unheard or dismissed when they did ask for help, which relates back to the issues surrounding stigma, that in society and in families men are expected to be strong, be breadwinners and provide.

Depression manifests itself differently in men than women, who most often express it through sadness, according to the National Institute of Mental Health. In men, symptoms may include rage, irritability and aggressiveness. They may also seem very tired or lose interest in family, work or hobbies.

Dr. Carl Nassar, president of Heart-Centered Counseling, a Littleton-based counseling and therapy center, said men are often taught or believe they need to repress their emotions. But emotions still emerge.

“Repressed feelings really come out primarily in three ways,” Nassar said. “If you repress a lot of sadness, it will build up into depression. If you repress a lot of anxiety, then you are much more likely to become anxious about a lot of things in life. If you repress a lot of anger, you’re more likely to have outbursts.”

Nearly 49 percent of women compared to 34 percent of men received care in 2016 for their mental illness, according to the National Institute of Mental Health. But that doesn’t necessarily mean women are struggling at higher rates.

“Women have much higher rates of depression but it’s because they go to the doctor and get diagnosed,” said Jarrod Hindman, deputy chief of the Violence and Injury Prevention Mental Health Promotion Branch of the Colorado Department of Public Health and Environment. “Men just suffer in silence.”

A call to action

The rising rates of suicide, considered a national public health crisis, paint a troubling picture of how many men struggle with mental health: Men represent 78 percent of all U.S. suicides, according to the CDC. And men are four times more likely to die by suicide than women.

State health officials also note that suicide was the seventh-leading cause of death in Colorado in 2016, according to the CDC. A report from the Kaiser Family Foundation named Colorado as ninth on a list ranking states by highest suicide rates for that same year.

That’s important when considering working-age men account for the highest number of suicide deaths in the state annually, according to a 2016-17 annual report from the Office of Suicide Prevention. Those men are also the least likely to receive support, according to Man Therapy, a statewide public health campaign that started in 2012 with a goal of getting men mental health resources.

Douglas County reflects the state and national pictures.

Data provided by the Douglas County Coroner’s Office shows of the 44 suicide deaths in the county last year, 35, or more than 79 percent, were men. In 2016, 39 of the 57 suicide deaths, or 68 percent, were men. And in 2015, 49 of the 58 suicide deaths were men. That was nearly 85 percent.

“The 10 states with the highest suicide rates are almost always the Rocky Mountain West,” said Hindman, explaining that numerous factors, including high gun ownership rates and the general culture, contribute to that reality. “We really embrace that rugged individual mentality in the West.”

The concerns around depression and suicide among men have galvanized local and state organizations and health departments.

A State Innovation Model grant workgroup recently evaluated gaps in Colorado’s behavioral health and this year issued a call to action asking Colorado to focus more on the male population’s health. The State Innovation Model is a governor’s office initiative aimed at better coordinating primary and behavioral health in primary care settings.

“That pretty much called out that we as a state are not really paying enough attention to the needs of men and boys,” said Monica Younger, a behavioral health coordinator with Tri-County Health Department, which serves Douglas, Adams and Arapahoe counties.

The Let’s Talk Colorado campaign, a statewide effort led by a partnership including the Tri-County Health Department and Douglas County government to destigmatize mental illness, is responding to the recent push by focusing its next campaigns on men, said Patty Boyd, Tri-County’s strategic partnerships manager. The department will work with Man Therapy next year for that campaign.

“We just wanted to draw more attention to men and their unique challenges to opening up about their mental health,” Boyd said. “We’re all in this together. We want everyone to understand that we all have to look out for each other. And men need to hear that message, too: We hear you, we see you, your ability to enjoy life matters.”

One of Man Therapy’s main goals is to reach men who might fit the “man’s-man” stereotype, but long before they enter crisis. The message: Taking care of one’s mental health is a sign of strength, not weakness. It’s about being the best man he can be.

Since Man Therapy’s start six years ago, Hindman said, the mission has been to change social norms and how men think of mental health, to empower them to address their mental health and to reduce the suicide rates.

Through a website, bilboards and advertising, the organization has used humor and a Ron Burgundy-esque character — modeled after actor Will Ferrell’s role in the movie “Anchorman” — to try to ease the stigma around mental health and grab men’s attention. A CDC-funded study is underway to gauge how the website affects men, with results possibly available in 2019, Hindman said.

Getting help and taking care of mental health can look different for each man, Whitley, Hopcus, Younger and Hindman said.

There are apps that can be downloaded — numerous options exist for helping people manage anxiety, sleep and more. Maybe it’s better diet or strategies to manage stress. Perhaps it’s finding connection with others through social groups or exercising. Or seeing a therapist and attending support groups.

Whatever the means, mental health officials are shining a spotlight on men to help those who are struggling avoid becoming a statistic and spiral toward crisis, like suicide.

“If you can catch it before it even gets there,” Nassar said, “that’s ideal.”

‘It makes you stop and think’

Before his panic attack, Zachman had moved out of the home he shared with his wife and two young sons and started his own promotional merchandising business. For the first time in his life, he lived and worked alone.

He dealt with his emotions in what he described as the machismo way: “I took the route I think a lot of men take. I don’t need anybody’s help. I don’t need help.”

He began withdrawing from friends and family, isolating himself. He threw himself into work. Internally, he felt like a failure. He hadn’t shared with loved ones how his marriage was struggling, and the divorce came as a surprise to them, he said.

Zachman was not suicidal. Still, he questioned where he’d be today had he not sought help following his panic attack, which he ultimately did through a group therapy program in Boulder. He also began individual therapy twice a month.

“It helped because it makes you stop and think about what you’re doing and why you’re doing it,” he said, “and brings an objective viewpoint.”

Today, Zachman, 47, works in finance. But he spends every Friday working on BeMen, a Parker-based nonprofit he started eight years ago because of his own experience. The organization’s mission is to help men navigate their mental and emotional health along with their overall well-being, and to help them find a community of other men.

“Men need a place to come and talk,” he said.

The organization began as a divorced men’s group meeting at Zachman’s home. Today it has a website, a Facebook page and offers meetings and events for men of all backgrounds, divorced or not, to come together. One recent event invited five panelists to talk about a range of men’s health topics — from mental toughness to financial freedom and physical fitness.

“If we help men become stronger,” Zachman said, “it creates an amazing ripple effect in society.”