Podcast: Why We Need to Talk About Men’s Mental Health

Jenn talks to Dr. Chris Palmer about men’s mental health. Chris explains why there’s still so much stigma present around mental illness in men, shares how we can talk to loved ones about their well-being, and answers questions about the silent mental health crisis occurring in those who identify as male.

Christopher M. Palmer, MD, is the director of the Department of Postgraduate and Continuing Education at McLean Hospital and an assistant professor of psychiatry at Harvard Medical School. For over 20 years, Dr. Palmer’s clinical work has focused on treatment-resistant cases. Recently, he has been pioneering the use of the ketogenic diet in psychiatry, especially treatment-resistant cases of mood and psychotic disorders.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hello folks. Good morning. Good afternoon. Good evening. Wherever you’re joining us from, and whatever time you are joining us, thanks for tuning into our chat about men’s mental health. I’m Jenn Kearney, and I’m a digital communications manager for McLean Hospital.

And typically it’s not my intent to start these sessions out with disheartening statistics, but sometimes the topic calls for it. And especially with so many folks that identify as male that consider mental health struggles as a personal issue, that could or should be internalized and not acknowledged.

I thought it was a good way to start just by showing what’s happening in male populations. So a couple of stats about men’s mental health, at least in the United States, proves that we really do need to talk about it, and why this discussion today is so important.

So the American Foundation for Suicide Prevention shared that in 2017, men died by suicide at a rate of 3.54% higher than women. And depression and suicide are considered leading causes of death among men.

In the U.S. every year, at least 6 million men are affected by depression. And men are two to three times more likely to misuse substances. And the average number of men dying annually due to alcohol related causes, is approximately 2.5 times greater than the number of women who do.

So, it’s my pleasure to have Dr. Chris Palmer with me today to chat all about men’s mental health, how we can work toward de-stigmatizing the subject, ways to approach it with our loved ones, and more.

So, if you are unfamiliar with Chris, you are in for a huge treat. I personally love Dr. Palmer. He is internationally known for pioneering the use of the ketogenic diet in psychiatry, especially in treatment resistant cases of mood and psychotic disorders.

And currently Dr. Palmer serves as the director for the Department of Postgraduate and Continuing Education at McLean. So, Chris, hi, thank you so much for joining me.

Chris: Hi Jenn.

Jenn: And, beyond what I’ve just mentioned. Why is it so important for us to talk about men’s mental health?

Chris: Well, I think you shared some really important statistics. I would say that to add to those that mental health, in general, is really important to be talking about because we do have a mental health epidemic, not just in the United States, but around the world.

Rates of all mental disorders, essentially all of them are increasing, in particular over the last 20 years. And mental disorders affect physical health.

So, although a lot of people distinguish between mental health and physical health, the distinctions are really kind of arbitrary and artificial in many ways. For example, people with depression are twice as likely to have a heart attack as people who don’t have depression.

People with depression are much more likely to develop diabetes than without depression. But it’s not just limited to depression.

It’s actually almost all of our psychiatric diagnoses that are associated with increased rates of heart attacks, strokes, diabetes and actually premature mortality. People with chronic mental disorders die early deaths.

I think one of the reasons it’s really important to focus on men’s mental health, as opposed to just mental health more broadly, is because men and women can have different symptoms of the same illness.

So if on average, for any one given diagnosis, sometimes men and women show differences in the types of symptoms they exhibit. But men and women can also have differences in the types of disorders that they are more likely to develop.

And Jenn, you shared some of those statistics, autism is another big one. Men are four times more likely to have autism spectrum disorders than women. But even when men and women have the exact same illness, people can perceive the exact same symptoms differently.

And this even applies to mental health professionals, mental health professionals make their own judgments, and they can sometimes interpret the same symptom very differently in a man versus a woman.

So I think it’s important to talk about some of these differences and talk about strategies for helping men who are struggling with mental health problems.

Jenn: I understand that there’s overwhelmingly a mental health crisis, at least in the United States. Would you say that in populations that identify as male, there’s a mental health crisis?

Chris: I think that there is, it certainly, the mental health crisis in the United States and the world is definitely not limited to women. For again, for some disorders, women are much more likely to be affected.

Women on average are about twice as likely to develop depression or an anxiety disorder. They’re more likely to develop post-traumatic stress disorder. And there are lots of reasons we think for that, some of them are biological and some of them are societal, psychological and social reasons.

But nonetheless, depression right now is the leading cause of disability on planet Earth. And that includes men. So the leading cause of disability for men on the planet is, and in the United States is major depression.

So, although women are more likely to develop major depression, it’s not like men are excluded from this. One of the things that will be important to just say up front, that there are all sorts of men and we’re kind of talking about men as though it’s one group, and whenever you do that it starts to sound like it’s a homogenous group. Like all men are the same.

And so I just want to make the obvious point, that we can speak in generalities, and I’m going to speak in some generalities, and I’m going to offer some stereotypes that hold some truth that can kind of apply to men more often than women.

By no means do I mean to imply that all men are one way and all women are another way, because that’s kind of ridiculous and crazy. As we’re talking about this subject.

I think it’s probably really important to just point out that I’m going to be making my comments primarily directed toward or about cisgender heterosexual men. So what do I mean by that? I mean, men who were born and assigned at birth the male gender, and continue to identify as male and heterosexual.

And why am I separating this? It’s not to discriminate. The reality is that for men who are gay or transgender men, or gender fluid individuals who might have some identification with the male gender, we know that they as a group, as the LGBTQ population have much higher rates of mental illness, they do.

This appears to be probably primarily driven by minority stress, but they have higher rates of depression, anxiety, substance use disorders and other disorders. And, so I am going to be making a lot of my comments really geared towards cisgender heterosexual men.

Not because those other men don’t matter, or they don’t count, or their mental health needs are different, or in many ways their mental health needs are greater.

And I’m absolutely happy to answer questions about that population, if people have specific questions, but I just want to make that point and I’ll stop there.

Jenn: And I can’t tell you how much I appreciate you making that point. Because when we consider populations that isn’t, we’re examining one side of the coin or the other, it’s everything is so multifaceted that we want to make sure that we aren’t caught, we’re not blanket assuming or addressing one population and saying, quote, “All men.”

When we full know that there isn’t one all men status out there. When I ask this question, there is going to be the blanket of men in general. But overwhelmingly, why are men less likely to seek mental health help? And I know this is a loaded question, so thank you for bearing with me.

Chris: Yeah, no, it is. And it’s, I think it’s, my comments just a little bit ago are a good kind of prelude to my answer for this. So I’m going to give the stereo, I’m going to talk about the stereotype of the heterosexual man. So men in our society still to this day are taught to not really talk about feelings.

And, I, there’s a lot of debate about is that all social and societal, is it societal standards that are different or could there possibly even be some biological differences that men tend to be less social than women overall, that men maybe have less of a need for social connection for really close friends that they can bond with, that they can talk to about their inner most feelings, those types of things.

But there do appear to be differences in the way that men and women relate with family members, with friends and others. And so, and there’s this theme again, not across the board at all, but there’s a theme in our society, men aren’t really supposed to talk, they’re not supposed to open up and talk about their feelings.

What are they supposed to do? They are supposed to be tough and strong. If they want to attract a really beautiful, wonderful, loving woman, what are they supposed to be? They’re supposed to be a knight in shining armor.

And what does that mean? That means they’re supposed to be tough. They are supposed to be fierce. Of course, they are supposed to be gentle men with their women. So they are not supposed to be tough and fierce with a woman.

But if another guy gives either of them any trouble, he needs to be tough and fierce, knight in shining armor, a warrior who is not going to let anything happen to himself or his woman

Jenn: So culturally, that’s like a cross between Popeye and Paul Bunyan.

Chris: Sure. I mean, we could, all you have to do is watch a Disney movie to get the stereotype here. And it is still, this stereotype is still embedded in all of our movies, in television. You watch any action adventure movie.

And they usually have some man on steroids, being a tough guy, going out and killing people. And, but of course, falling in love with this woman and treating her with kindness and respect and gentle. But he is the tough guy.

Some women in fact, again, our culture is designed around this stereotype. So some women buy into this, and they want their man to be like that. Some parents expect their sons to be like this, don’t cry, don’t, pick yourself up, dust yourself off.

Don’t you cry on the baseball field when you’re playing baseball. Don’t you cry on the soccer field. Don’t, suck it up. Just get back in that game. Be tough. Some business people in the business world expect their employees to be this way. You want to rise up.

You want to get a promotion. You want to be on the leadership team. Then what do we expect? We expect you to be tough and strong. You are not here to talk about your feelings. You are certainly not here to cry. Don’t you ever dare do that.

And don’t you ever show weakness or vulnerability, which is different than, I’m not saying that we’re looking for people to be uncivil. I’m not saying we’re looking for people to be hostile or violent.

But we are looking for tough, assertive, unflinching, unbothered by stress, resilient. And so, why would men be less likely to seek mental health help?

Because seeking mental health help goes against all of that and says, “I am suffering. I maybe don’t have control over my thoughts or my feelings or my behavior. I need help. I can’t be the tough guy right now. I don’t know that I can manage this.”

And in general, if men come forward with that kind of a message, there are a lot of people in our society that are going to tell them, “Suck it up. Why are you, oh my God, how embarrassing for you to even say that? Don’t say that, don’t you dare say that to anybody at work. You’ll get fired, or you’ll definitely be lowered on the list for who is going to get promoted next or who’s going to be given the big assignment. So don’t talk about that.

Don’t, and don’t tell your girlfriend about that. She doesn’t want that. She’s counting on you. You’re supposed to be the tough guy for her. She doesn’t need to be taking care of you and babysitting you, you got to be a man, man up, man up. That’s what man up means. Man up, suck it up. Be tough, no whining, no complaining, no excuses, just do it. Do your life, and don’t complain.”

Jenn: And it’s so hard when that type of language and that attitude is so heavily embedded in so much of our socio-cultural upbringing that it’s hard to break that stigma.

Chris: I think in many social circles, it can be impossible to break that stigma.

Jenn: Kind of like going up Everest without an oxygen tank.

Chris: Yeah, no. And I think it drives people oftentimes to a point of crisis, where they really can’t go on, and they can’t continue to hide their symptoms.

They can’t continue to pretend to be okay or to pretend to be tough and they might get hospitalized, they might get arrested, they might try to kill themselves, they may overdose, whether that’s an intentional suicide attempt or just an attempt to escape what they’re going through. But those types of behaviors can drive people to crisis situations.

And now they need help, but those, all those stereotypes that I just mentioned they don’t go away. Now it’s shame and humiliation. I am weak and vulnerable and I couldn’t suck it up, and I couldn’t do it. And now I’m just humiliated.

Jenn: So we had someone write in saying, “Until we drop the word mental from mental health, I don’t see use or uptake of counseling/ mental health treatment among men changing.” I’m curious whether or not you agree or disagree with the statement.

And I’m curious to know if you think that using language like mental health is actually contributing to the stigma of mental health in male populations.

Chris: It’s a really great question. And I will say just personally, professionally based on the work that I do about the interface between physical disorders and what we call mental disorders, you’re kind of preaching to the choir with me.

I 100% agree that mental disorders as far as I’m concerned on average, as a rule of thumb are brain disorders. And it’s about the brain not functioning properly. It, at the bottom, it as a simple statement. And the symptoms are all over the place, lots of different disorders, lots of different symptoms.

At the end of the day, it really is about the brain not functioning properly, in some way or another, that results in changes in emotions or behaviors or thinking, motivations. Changing that is an uphill battle. People have been fighting that battle for decades and have largely gotten nowhere.

So changing that is going to be extraordinarily difficult. The reality is that a lot of our, I think part of the stigma of mental illness is that a lot of the disorders are kind of reflections of normal human experiences, but they have gone awry.

And what I mean by that is everybody gets anxious. Everybody gets anxious at some point or another. Anxiety is a normal part of being a human being.

And an anxiety disorder is when those anxiety circuits are firing when they really shouldn’t be, or maybe they are hyper reactive, so that even if they are triggered by an understandable kind of stressful situation, they’re exaggerated, the intensity of the anxiety is much, much greater than it is for most other people. And it becomes overwhelming for the person with an anxiety disorder.

One of the reasons that’s so stigmatizing is because a lot of people think, “Well, I’ve been anxious. What’s wrong with you? I’ve been anxious, but I come up with a plan, if I get anxious about a test, I come up with a plan, I study, and I get through it and it works out okay. So why can’t you do that? You just need to do the same thing I do, ‘cause I’ve had anxiety too. And so you should just do what I do and everything will be okay.”

And then if you come back to me and say, “Everything’s not okay. You’re not getting it. My anxiety is worse than yours.”

A lot of people are like, “Whoa, who are you to say your anxiety is better, worse than mine? I have bad anxiety too. I had a really stressful situation and I work hard.” And it gets into these ridiculous battles and judgments and other things, of course, it’s not just about anxiety.

Everybody gets depressed. Everybody has all sorts of experiences, and everybody eats maybe a little more than they should or diets sometimes or drinks more than they should or whatever.

And that’s kind of, get to a point of like, “Oh, could I be becoming an alcoholic?” And then it’s like, “Well, no, I’ll get it under control. Well, if I can get it under control, you should be able to get it under control. And if you’re not getting it under control, you’re clearly just not trying hard enough.”

And so the challenge is, I think that in my mind is one of the biggest challenges, is that disorders of the brain reflect normal brain functions. And so a lot of people get really judgmental about them.

But they do reflect mental state, and that is, I think that’s going to be one of the other big challenges of getting rid of the word mental, is anxiety is a mental state, and we don’t have a measure of it.

We have to ask people, are you feeling anxious? And that’s the only way we’ll really know what they’re feeling or what they’re experiencing. And that alone kind of makes it a mental state and then makes it challenging to address the stigma.

Jenn: And a lot of times too, if you don’t know what to expect when you’re feeling anxious or depressed. If you say to somebody, are you anxious? They’re going to say, “No, but my chest hurts.” And you’re like, “Maybe that’s anxiety.” They’re like, “No my chest hurts.”

Chris: Well, and yeah, no. So that’s a perfect example of the stigma kind of influencing what people are willing to say, and what they aren’t willing to say.

And so in that situation, it would be hard to know. Maybe they’re telling you the authentic truth. Maybe they genuinely don’t, they’re not experiencing what they would consider anxiety, that they really are experiencing is chest pain.

And that absolutely happens I think for some people, but other people it really becomes those shame and stigma thing of, “Well, I’m not going to admit that I’m anxious, but I’ll admit that I have a physical symptom, chest pain, or some other type of pain or a headache or something else.”

Because that’s less stigmatizing. And that, tough people can still have chest pain whereas tough people are not supposed to be anxious.

Jenn: So I’m curious with the full knowledge that disorders, mental disorders pop up differently in different people. And knowing that full well, some people don’t, they have a very negative, or neutral affect rather, that they don’t really show much.

Are there any telltale signs that somebody that identifies as male might be struggling with their mental health?

Chris: They, I think there are, and some of them are obvious. I’ll mention some kind of symptoms that I think should at least raise concern for people about whether somebody might be struggling with a mental disorder: depression, mood instability, this could include irritability or rage attacks.

It could also include mania, manic symptoms, euphoric symptoms as well as depression. Psychosis is obvious to most people, deficits in social skills, that might reflect an autism spectrum disorder or something else going on, excessive use of alcohol or drugs.

Sometimes it’s really about social withdrawal though. So sometimes again, people can be really good about keeping everything inside, but because of what’s happening inside their head, they, and what I mean by that is in their brain.

I don’t mean it’s all in your head. I mean that your brain is in your head. And so what’s happening in their brain is distracting them from being able to do what they should normally do.

And that might kind of reveal itself in terms of social withdrawal or a decline in performance in schoolwork or at work. It might be trouble sleeping. It might be excess worrying. And on the other end of the spectrum since we’re talking about big strong men, excessive steroid use is, and supplement use and everything else is really a disorder.

And for better or worse, it’s a disorder that tends to get a lot of praise and support and recognition, and a lot of sexual partners like that, women see a guy on steroids and they think, “Oh, he’s ripped and he’s big and strong. Oh, I like that.”

And of course, all you have to do is, again look at all of our movies, look at all of our television shows, look at all of our magazines. And if you see a man without a shirt on what does he look like? He looks like he’s on steroids more often than not.

Jenn: So I’m curious because I know a lot of the, a lot of our discussion about mental health can be subjective. A lot of, it is truly based on oftentimes how people are feeling.

So what are some ways that providers can start the discussion about their patients seeking mental health help through collecting qualitative data? What kind of questions can they ask to get that conversation going?

Chris: Are you providers or are you talking about family and friends?

Jenn: Providers. ‘Cause I know that there’s screening questionnaires, but are there any other ways that they can start those discussions?

Chris: I usually start those discussions in kind of the, so if somebody’s coming to a provider, that’s actually the biggest obstacle, is making an appointment, actually getting an appointment with a mental health professional, it can be next to impossible these days.

So if you have gone to the trouble of being able to get an appointment with a mental health professional, and you actually show up to that person’s office, those people are golden.

They’ve done the hard work. They’ve recognized they have a problem. They went through all the obstacles in place to be able to get to a provider’s office.

And, so usually it’s pretty obvious. The provider will ask basic questions. Why are you here? What brought you here? What’s worrying, what’s bothering you? How can I help? And those people usually know perfectly well why they’re there and what they hope to get.

They may not understand everything that they’re experiencing or suffering from. They may not recognize that some of the symptoms they have are actually symptoms of a disorder.

They might think, “Oh, I’m just really irritable. And I keep yelling at my girlfriend and she told me if I don’t get help, she’s going to break up with me. So that’s why I’m here.”

And then in talking to that man I might find out he also drinks excessively. He feels extraordinary pressure at work. He feels like he’s about to be demoted or fired. He had a long standing history of ADHD, and maybe that was playing a role.

So I could unpack a lot of different diagnoses for that one complaint of, “I’m yelling at my girlfriend, she’s fed up and she told me you to get help.” But he still came. And, so those are the easy ones.

Jenn: So we actually had a med student from Iran ask that they have female patients that easily accept advice to seek mental health follow-up care.

But they’re getting resistance from male patients. In your opinion, what are the probable reasons for this? And how would you address this when talking to men about following up regarding their mental health?

Chris: So it’s right in line with what we’ve been talking about, the stigma and humiliation of having a mental disorder. And for a lot of people in general, this includes women too.

It includes children. If you say, “Oh, I think you need to go to a mental health professional.” Lot of people will be offended by that, if they don’t recognize they have a mental health problem.

They will be highly offended by that suggest, “How dare you? Who are you? Who do you think you are telling me I’ve got, you think I’m...”

And again, it goes into the different stereotypes, and there are a lot of, there are different flavors of stigma when it comes to mental illness. So it could be, “You think I’m crazy?” Or it could be, “You think I’m a whiner and complainer?”

Or it could be whatever it is, they’re usually not good. They’re never good, these stigmatizing stereotypes. Again, women, women in our society as a general rule of thumb by no means for every woman, there are lots of women who are raised with you.

Don’t talk about your feelings, be strong and tough. You’re going to be the President of the United States or whatever. But on average, women are encouraged to talk about their feelings with someone.

Now, that could be girlfriends, it could be parents, it could be a teacher, it could be anybody, but talking about feelings it’s kind of okay for women. And so I think women are used to talking about their feelings.

And so if somebody makes a referral for a mental health problem, usually at least more often than not, that woman might interpret that as, “Oh, you heard what I just said, you took it seriously. And you want me to talk about my feelings even more with someone else with a professional.”

And again, that doesn’t go against her role in society. If she has been kind of raised in that type of an environment where those expectations are made clear. For men and even boys, it really, for boys it would be, “I’m in trouble.”

And for if you’re sending me to a mental health professional, “I’m in trouble. You must think I’ve done something really wrong.” And for men, it goes along with that flavor that, “I’m in trouble.” Or, “You think I’m crazy or disturbed somehow.”

And so I would say the way that I usually work to get people to at least consider going is to align with them not around a diagnosis, not around the word mental at all. I’m going to avoid the word mental. And instead I’m going to use whatever language they use.

When they told me about the problems they were having that made me want to make that referral to begin with.

So if they say, “I’ve been really stressed at work and I can’t take it anymore. My boss is ridiculously controlling and I can’t take it. He’s going to fire me. I just know it. And I can’t sleep at night. And it’s really just overwhelming. And I’ve been more irritable with my wife as a result.”

I’m not going to say, I’d like you to see a mental health professional, not going to say that, I’m going to say, “Your stress sounds like it’s really getting the better of you. Sounds like you could use some help with all that stress. And certainly maybe use some help with getting some sleep and maybe just figuring out how you can get yourself a little stronger a little more resilient to the deal with your difficult boss.”

I’m not going to challenge their perception of the boss. ‘Cause maybe the boss is actually perfectly fine. And this person’s performance is really declining rapidly, and it really is on them. I’m not going to challenge that in a quick referral.

If they come to me for help, I’m going to start to at least get at that like, “Do you think it really is your boss or has your performance changed? Is that part of what’s going on?”

But I’m going to use the language they use. I’m going to use the problems that they’ve identified to simply say, “I think this other doctor.” Or, “I think talking with this therapist might help you.” And why, I’m going to get really granular on how it connects with that person.

So if I’m going to refer to a therapist, I’m going to say, “I think this therapist,” let’s say it’s a female therapist, “I think she might be able to help you with some of that sleep problem. And you know what? That’s going to help you deal with everything you have to deal with.

‘Cause when you can’t sleep, that just makes the next day even more stressful and even worse. And now you’re not thinking straight at work and it just snowballs out of control. And I want to help you be as strong and resilient as you need to be to either figure out how to stay in this job or figure out how to get a new job. And I just want to be of help to you. I want to be of service to you. And I think this person might be able to help you do that.”

That’s about the best I can offer right now. I can, you can get more granular with different situations, but I would avoid the words mental. I would avoid the word psychiatrist, psychologist, I would frame it around whatever language and whatever complaints they offered.

Jenn: So I know a decent part of our discussion so far has been about men that have sought out and found help. But what do we do as members of society about the folks that don’t want help?

How can we work on normalizing help seeking behavior for men other than forcing folks into a hospital during an acute episode.

Chris: So, it’s going to go along with exactly what I was just saying, in terms of making that referral. I’m going to look for, I’m going to encourage you as a family member or a friend to, if you’ve got somebody in your life that you think is struggling, to at least start to open up the conversation and be very specific.

Avoid the word mental and avoid the word, any specific diagnoses. Diagnoses almost, usually are not helpful in these situations especially in people who are reluctant to seek help, giving them a diagnosis is not all that helpful.

Talking about the specific challenges they are having can be enormously helpful. So I just, “Hey dude, I’ve noticed that you seem a lot more stressed lately, is that right?” Or, “I noticed that you’re not sleep...Son, I noticed that you’re not sleeping very well lately. I heard you up last night again, what, are you okay? Is sleep okay? Is anything bothering you? Is something going on?”

See what they offer. If they say no, I’m fine. If that sleep disturbance is persisting, I’d bring it up again and say, “I know you said you were fine, when we talked four days ago, but I’ve heard you up every night for the last four days. And I just, I’m worried that, I’m worried that you’re not sleeping very well. And sleep, if you don’t sleep that can really take a toll on your health.”

Not, I didn’t say mental health, I said health. It includes mental health. It does include physical health. You’re not lying, but it includes all health. So, but that’s the kind of language that they’re going to be more receptive to hearing.

And then again, similar conversation that maybe somebody could help you with this. I don’t know what to do to get you to sleep better. If you have some one or two ideas, offer them up.

But if they don’t work, or if the person’s already tried them, then you’re going to get to a point where you say, “I’m not sure how to help you, but I really care about you.” Or “I love you.” Or whatever.

And there’s got to be somebody who can help you with this. This happens to a lot of people, you’re not alone. This is not uncommon. So, your life would probably be a lot better if you were sleeping.

Or your life would be a lot better if you were drinking less, or you had better control over your use of alcohol, or your life would be a lot better if the aliens weren’t beaming thoughts into your head.

If you get somebody who’s having psychotic symptoms, the aliens are beaming thoughts into my head, roll with that symptom. Don’t talk about schizophrenia. Don’t use the word psychosis.

Say, “That must be awful to have aliens beaming thoughts into your head, that must suck. But I’m wondering if maybe we can get some help, to get these aliens to stop doing that kind of stuff to you.”

Not even going to argue with them about, “Don’t be ridiculous. You sound crazy. No aliens are beaming anything into your head.” Unfortunately, more than likely you’ve already started there and it went nowhere, because if it really worked, the person did not have psychosis.

If you told them aliens aren’t beaming any thoughts into your head. And they said, “Oh, okay.” Then they really did not have a serious symptom, but they must have been mistaken. But...

Jenn: So what I’m hearing is we need more empathy, less shaming and less dismissiveness and acknowledging that where your help, whether it’s listening or giving advice, acknowledging where you end and where somebody else can continue to help and take over. It’s like passing the baton in a relay race.

Chris: It is, and I think that can be really important for family members. And I’ll say just one more, kind of expand on that just a tiny bit more ‘cause so often family members want to say, “You need help. You need help. Let’s take you to the psychiatrist.”

That does nothing for shame and stigma, that does nothing to get you good graces in terms of actually getting them to that, it might work, but more often than not, it’s just shaming and stigmatizing.

If instead you say, “I really love you, but, and I’m so worried about you, this these things are happening.” Or “You’re not sleeping.” Or whatever. And I don’t know how to help you.

So you’ll notice I said, “I love you. I want you to get help but I don’t know how to help you. So together let’s see if we can find somebody who might be able to help you.”

So you’re not abandoning them. You’re not, you’re actually saying, “I’m in this with you because I do love you.” We together are going to see if we can find somebody who can help with this. So it’s not, “You’re crazy, go to the psychiatrist. I’m sane, so I’m staying home.”

It’s not that, now the person might want to go alone and that’s fine. I’m not saying you have to go with them, but I think you should offer to go with them. And because it goes a long way for people to feel like somebody’s really in this with me, they really must love me.

And they’re really in this with me. And again, when people have a serious mental disorder, they are impaired. Finding a mental health professional is next to impossible these days. They may very well need your help figuring out how can we get an appointment?

You may have to call your insurance company. You may have to call multiple mental health professionals to get an appointment. So they might need your help with that process. And that can go a long way in getting them services as well.

Jenn: So, you know and I know that language matters especially when addressing mental health. Someone wrote in saying I’m the youngest of four siblings and all of my brothers were affected by a mental illness, but I wasn’t.

One of our family members has an issue with the use of the word crazy. Do you have any feedback on the use of that word?

Chris: I would, I guess I would say this, you’ve heard me use the word a little bit ago. It’s a highly stigmatizing word for some people. I guess I would say this, if you’re dealing with chronic mental illness and family members, it’s also important to be able to be genuine and authentic and real.

Sometimes it’s even important to be able to joke about mental symptoms. And I don’t say that lightly, and I don’t say that because mental symptoms shouldn’t be taken seriously, mental disorders aren’t serious.

But people have a wide variety of coping strategies and sometimes humor or joking or whatever is part of that. And might the word crazy come up, it might.

But I would say, if you have a particular family member who is really triggered by that word and you know that, and they don’t see it as joking, they don’t see it as funny whatsoever they are assaulted by that word. They feel insulted. They feel like you are disrespecting them.

I would say, as a family member it’s really important for you to just be mindful of that and probably avoid using that word around that person. Why? Not because I’m a big fan of political correctness.

It’s not about that, it’s about just basic human decency, that if I have a friend or colleague or family member who says, “When you do this…”or, “When you tell me to go on a roller coaster, even though you know I hate roller coasters and I’m terrified of them it makes me feel ashamed. Stop telling me to go on roller coasters.”

I can either torment them and continue to say, “Come on, let’s go on a roller coaster. You wimp, why aren’t you going on a roller coaster?” I can point it out to other people, “Oh my brother’s afraid of roller coasters.”

But that’s just cruel. That’s just being cruel. If I really care about my brother, I’m going to respect whatever it was he said. Again, this isn’t about political correctness. This is about just listening to the human beings in your life, and negotiating in one way or another, and coming to compromise on things about, you have your own needs, we all have our own needs.

So it’s not like, “Everybody gets to ask me to change my behavior and I have to change everything. And nobody ever listens to me. I don’t get to do anything I want to do.” But with the word crazy, I would be hard pressed to understand why somebody must be able to use the word crazy around a particular individual.

I’m not sure what, how that would really benefit that person. But if it’s really being experienced as cruel by the other person, I would say in that case, at least as a psychiatrist, I would argue in favor of maybe that word should not be used around that person.

It doesn’t mean you can’t use that word with your own friends and joke about, “Oh my God, my whole family’s crazy. I can’t take it.” Or, “Oh my God. My whole family is crazy. There’s always drama going on. My brother’s in the hospital again. It’s so overwhelming. It’s so stressful. Why am I the only sane one?”

I want you to be able to say that, if you’ve got close friends, if that’s your way of venting to your close friends and getting the support you need to be able to remain engaged with your family.

I’m all for it. But if your brother is around or whoever this is, if that person’s around and you know they’re really triggered and insulted by that word, maybe don’t say it around them.

Jenn: So we had someone write in asking if you had any advice for a gay male who does not want to be public in that regard, but also wants to stay mentally healthy.

Chris: Great question. At the end of the day, the real answer depends on so many social circumstances that that gay male is in.

So if I take it to the extreme, I’m going to assume this gay male does not want parents to know, does not want siblings to know, does not want anybody at work to know, does not want work friends or other, I guess I would say first and foremost, at a minimum, there better be somebody in your life who knows who you are.

There’s got to be somebody, at least one person. We all have secrets. Every one of us has secrets. Every one of us has at least something in our lives that we’re not really proud of. And maybe that we’re even ashamed of, something that we’ve done. We had an impulsive moment. We were really cruel. We got drunk, whatever.

We did something that we’re not proud of or that we’re ashamed of. And for far too many people, that’s what being gay is like. It’s something to be ashamed of. And that comes from society. I don’t agree with it. I don’t like it one bit.

I would love for society to change that mindset. But a lot of people still learn that message, and still accept that message that being gay is something to be ashamed of. So, and I would say that, most gay men certainly most, will hide their sexual orientation in certain situations.

If you are in the middle of a really dangerous, kind of homophobic rally, where people are chanting death to the gays and you’re alone I think you’d be a fool to identify yourself as gay in that situation.

I just think you’d be a fool. I’d say, get out of there, just run, walk the other way just get away from that situation because those people might beat you up or kill you. And that’s not going to help the cause to get beaten up and killed. That’s not going to do any good to anybody.

So when you are overwhelmed by people who are hostile to you, it’s good to escape. Or, if you can’t escape, shut up, just blend in just put your, lay low, get through it, survive. And so we all have situations like that in our lives.

And, we all have to make choices, but I come back to, and yet all of us need to be able to be our authentic selves with at least one other person, preferably a whole lot of people, preferably a whole community of people, that might include friends, family, your entire neighborhood, whatever.

But at a minimum one person who knows you and again, and then if you can expand that to yet another person, I think it’s hard to stay mentally healthy, when people feel 100% isolated and alone. Human beings are made, we have hardwired into our brains the need to be with others humans.

And being with other humans who know us, who trust us, who respect us, who love us is protective for us. And when we don’t have even one person on the planet who knows us, loves us, respects us.

The world is a very hostile place, and it’s hard to not experience mental symptoms, anxiety, depression, insomnia, loneliness, something, it’s hard to not experience that. So I would say to the person who chooses to be closeted, that is fine. And maybe your circumstances actually do require it.

If you are really ambitious, you want to work your way up in the law firm. And the law firm is all homophobic people. You could look for a different job. Maybe a different law firm would be a better fit, but if you really are hell bent on, “Nope, this is the law firm I’ve got to be in. And this is my career path. This is what I want to do, fine.”

But make sure when you leave that law office that you’ve got somebody somewhere that knows you, that loves you, that respects you, that you can count on.

Jenn: So how can I talk to my partner, friend, brother, parent, in-law about their mental health and getting them to consider their mental health?

Chris: Again, it’s similar to what I’ve been saying. So try to identify concrete problems. Talking generically about mental health almost never is helpful to any human being, even people with very serious clear profound disorders.

If I see somebody let’s say personally in my life who I think has schizophrenia, I would not approach them and say, “I think you have some mental health issues and should see a psychiatrist.”

I would not say that, that will offend them on average that will offend them. They will get mad at me. They will not seek treatment, and that will not help anybody. It will actually damage my relationship with that person. That person will not end up getting treatment. I will have done no good by doing that.

So instead, I’m going to focus on the things that I see as problems. That they too are going to agree are problems. So sometimes you have to spin it. And this is really an art. There are no right answers, but sometimes you do have to spin it.

So if somebody’s paranoid, “The aliens are after me. And why are they tormenting me? Please help me. Please help me stop the aliens.” I’m not going to get into an argument, early on I’m going to ask them, “What aliens? Tell me more. I want to understand what’s happening to you.”

As soon as I recognize they are having a psychotic episode, I’m probably not going to argue with them anymore about there are no aliens. They’re not doing this to you. It’s not happening. ‘Cause again, that won’t go very far.

But instead I’m going to say, “You must be really stressed given all of this shit that the aliens are giving you. How are you holding up? Oh my God, if aliens were attacking me, I would like be a mess. What are you doing? How are you holding up?”

That might be a window for you to get at, “Yeah, no, I am a mess. I can barely sleep. I’m doing this. I’ve lost my appetite. I’m losing weight. It’s horrible. You don’t know how bad it is.” I might be able to align them in terms of seeking mental health around those other issues.

You know what? Now more than ever, you need to be as strong and resilient as possible because these aliens are attacking you. And, or because of the stress that you’re under.

If you want to say it that way, because of the stress that you’re under, you need to be resilient and strong as possible now more than ever. And getting good sleep, being able to eat, dealing with all this stress must be overwhelming.

Maybe we could find somebody who’d be willing to help you with that. Sometimes you can get an alliance around that. Sometimes you can get people to accept help in that way. Sometimes you can’t, they’re going to know you’re sending me to a psychiatrist, you think I’m crazy, don’t you? I’m not crazy.

And for some people it has to result in a crisis. When there’s more subtle symptoms say somebody who’s overusing alcohol. I noticed that you’re hung over a lot these days every morning.

And you’re kind of, you’ve been late to work for a few times or you’ve whatever. I’m not going to come out and say, “I think you’ve got an alcohol problem, dude. You need to go get help.” That’s not going to be very effective.

It’s just, that might be what you’re thinking. Fine for you to think that, don’t share it with them, instead, share with them your observations about why alcohol is a problem.

“I’ve noticed that you’re sleeping in more, that you seem hung over in the morning. You don’t seem very clearheaded. You’ve been late for work, or you blacked out, I noticed that you blacked out and I’m really worried about your safety when you black out.”

Whatever. “And maybe we could get you some help, or maybe you could use some help to see if you could just get better control of your drinking so that it’s not so dangerous.” And see if that kind of a discussion can help.

Again, the reason people are going to seek mental health care is because they have something they want help with. Nobody wants to be forced into anybody’s office against their will for a problem that they do not believe they have. Nobody on this planet wants that.

So, that the strategy overall is to see if you can figure out what will they identify as a problem. If it’s not the aliens, if it’s not alcoholism, what will they be willing to identify as a problem? Try to get them to verbalize that to you that, “Yeah, no, you’re right. That is a problem.”

And then, again you might offer some advice initially, “Have you thought about cutting back on your alcohol, have you ever tried, do you want to give it a week? I could be kind of an accountability person with you. Let’s see if you can do it for a week, cut back.”

‘Cause nobody’s going to go to a therapist or psychiatrist for alcoholism without attempting to cut back first. So you’re going to be an accountability buddy and try to help them cut back. If that works great, you have been an effective mental health advocate provider, whatever, friend, family member for that person and it has worked.

But if it doesn’t work, then that’s when you, as the accountability buddy you’re going to say, “Gosh, I’m worried because we talked about this a week ago and it seems like it’s not getting any better. If anything, it seems a little worse this past week. What do you think?”

And, if they want to try it again, try to cut back again, try a different strategy, let them do it. But at some point you’re got to say, “I’m really worried about you. I don’t think I know enough to be able to help, but I want to help you with this. Maybe I would go with you if you want, maybe we could try going to a therapist,” in that case.

It could be an alcoholics anonymous meeting. It could be a hospital for detox. It could be lots of things, but...

Jenn: So do you have any advice about mental health disclosure in the workplace? ‘Cause I know sometimes disclosing that you have a condition might actually help create a healthier work environment for you. But a lot of folks still feel that it has significant risks to disclose.

Chris: It’s a great question. And again, the answer really depends on the specific work environment that you’re in. So I would say it’s actually, is a rule of thumb for most of my patients, this comes up, I’ve dealt with this question for decades now.

And as a rule of thumb what I tell my patients is on average, look out for yourself. It is not your job to share your diagnosis with your employer. That is not on you. It is not your legal obligation. It is not your moral obligation.

And so, unless there is a good reason for you to tell them, err on the side of caution and err on the side of protecting your own interests and don’t disclose.

Now I know that goes against the anti-stigma campaign of mental illness, because we’re really going to de-stigmatize mental illness, everybody in the world needs to come out with their mental illness and about their brothers and sisters and themselves and everybody.

Unfortunately we are nowhere close to de-stigmatizing mental illness. And so if you’re, if I’m talking to an individual person like my patient, I’m not going to ask them to wage this monumental war and lose.

I know they will probably lose the war. I’m not going to ask them to do that. That has to be a larger movement. And it really needs to be an organized movement that includes tens of thousands, if not millions of people.

But if there’s a reason for you to disclose it, say you are in and out of the hospital because you have a manic episode or suicidal depression or alcohol detox or something, and you are in and out of the hospital, then it is going to be, it probably is going to be important ‘cause it’s affecting your work performance, it’s affecting your availability.

And then I would say, you’re probably going to get fired if you don’t have the conversation. So maybe have the conversation on the hopes that your employer will be understanding, and will be willing to make some accommodations and allow you to keep your job.

Jenn: You’ve touched upon this lightly in previous questions. And I would love to finalize, wrap up the session by asking the issue of men’s mental health and stigma surrounding seeking care has been discussed for more than 30 years.

And, like you’ve said it’s kind of been one step forward, two steps back. We’ve made some progress while not making much progress at all. How can we as functioning members of society help move it in the right direction?

Chris: To be honest with you, again, I’m going to say the same thing that I just said, we have to have a movement. Just like there was a movement for HIV Aids, just like there have been movements for breast cancer, Parkinson’s disease.

We, as a society need to get to a point where are willing to have a movement. And that means people marching in streets. It means people raising money. It means people calling congressional representatives.

It means people calling insurance companies demanding equal coverage. And I would say, there’s, I happen to be aware. I have some inside knowledge, stay tuned for a movement, possibly within a year or two, there may be an opportunity or a movement. But I think realistically without that, you’re right, it’s been going on for decades.

So I’m not going to give you the same answers that they gave you 30 years ago, that we know don’t work. ‘Cause it’s just disingenuous to say that those answers are going to somehow miraculously work now.

Jenn: But I do have to say that one of the steps in moving in the right direction is if you tuned in, you’ve already learned stuff from me and Dr. Palmer today, Dr. Palmer, you providing all of this insight over the last hour plus is another step in the right direction.

So thank you for providing your time, your expertise, your empathy, and your candidness. I really appreciate everything that you’ve done to help really enrich this series and especially talking about men’s mental health.

It’s, I’ve been really excited to talk about this for a long time, because I know that it’s so unaddressed and I’m the loudest person around my male counterparts saying, “Take care of yourself, seek help, be nice to yourself, be nice to other people.”

And I hope that anybody tuning in can do the same for themselves. So this actually concludes our hour plus discussion. Dr. Palmer, thank you again so much. This has been phenomenal and thanks for tuning in.

Until next time, definitely be nice to yourself. That’s the key takeaway here. So, thank you. Take care.

Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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