Why Diagnosis and Treatment Is That Much Harder For Men
In researching this blog I've found out lots of things. I have found that most of the evidence about male mental health is old and out of date; that one in ten men in the UK experience depression each year; but that those men are less likely to seek support and when they do reach out they are less likely to get the help they need (see link here). I've seen first-hand what the statistics mean in practice.
My husband is incredibly articulate and acutely aware of his condition. He knows exactly what is going on; he is not in denial and can explain his symptoms and their implications in great detail. The problem is that he will only articulate them to me.
I’ve known about my hub's depression and anxiety for at least the last eight years. He's tried seeking professional help four times and each time it has been a huge decision and a big achievement to actually reach out. Let me explain what happened. I expect that his is not a unique story:
He tells the Dr that he is depressed. He gets a survey. The Dr tells him to exercise more, drink less caffeine and alcohol and eat better.
Time 2 (about a year later):
He tells the Dr (a different Dr) things are worse. They send him for blood tests which find that everything is ok. He feels like a failure and even guiltier about his depression as there is no medical ‘cause’. He doesn't go back and no follow up appointment is scheduled by the Dr to talk to him about the blood test results or what to do next.
Time 3: (more than a year later)
After much haranguing by me he sees yet another Dr. I want to go with him but he tells me no. He is offered talking therapy which he declines. He's offered drugs which he takes. No follow up appointments are scheduled. Three months after starting the drugs he decides to stop cold turkey. They are making him fall asleep while looking after our baby; he slept through school pick up and didn’t get our kids. He doesn't tell anyone (including me) that he's stopped.
Time 4: (Another year later - Sept 2015)
This time is different. His depression and anxiety is at its very deepest and most severe. He hasn't earned a regular salary for a year. He has no faith that anyone can help him. He still doesn't want to go back to the Dr.
This time though I put my foot down. I make the appointment and he lets me come. I ask him beforehand if I can share some of the things he has written about how his depression and anxiety is affecting him: That he is confused and can’t make decisions, that he can’t concentrate or plan and organise things; that things don’t make sense and he flies into a real rage for things he knows are insignificant; that he’s exhausted and everything, even just taking a shower feels overwhelming; that he feels ashamed and weak and a failure to his family. He says no, that these are private things he has written to me.
I sit beside him and listen to him describe his condition. He explains very calmly and with no emotion that things are ‘a bit rough’, that he didn’t really like the anti-depressants that they made him tired, he seems coherent and together and downplays his symptoms and their impact.
At this point I cut in, burst into tears and explain (using the notes I jotted on my phone beforehand in the waiting room) exactly how and why we are both at breaking point. By the end of the appointment the Dr has given him a prescription for new medication, an appointment to come back in a week to see her (the same Dr!), and told him to call during the week if he is struggling as the medication is likely to make him feel worse in the short term. She gets him to do a questionnaire about his symptoms and gives him an emergency referral for talking therapy. She commits to reviewing the medication and the therapy on a regular basis.
Now, I don’t want to come over like I think I am some knight in shining armour, riding in to rescue my hub from his evil illness; or that my emotional outburst meant we got a better outcome. I am not a knight and I don’t think that’s what I’ve done.
It may have been that it was just luck, that on this fourth occasion we finally got a Dr who ‘gets’ mental health. But, part of me also thinks that there is truth in the stereotype that women are more comfortable and less stigmatised about talking about not just their feelings and emotions, but their mental health. Indeed, both the ONS (the Office of National Statistics) and NICE (the National Institute for Clinical Excellence) reckon that male depression statistics are lower because ‘women are more likely to report symptoms of common mental health problems’ and ‘depression in men may have been under diagnosed because they present to their GP with different symptoms’.
On the way home from the Dr I asked him how he thought the appointment went. He looked over at me as we drove and said with a smile ‘well clearly I should just outsource all my consultations to you, you explain it better than me’.
I really can’t understand why my amazing, passionate, clever and most of all deeply insightful husband hasn’t been able to say the things he says to me to a medical professional. But I do understand that we need to do more to support men to speak out, to remove the shame and the stigma that makes them feel they can’t fail, that they have to provide and they must be strong.
I think that family doctors need better training to understand that men are going to present differently, and that anyone coming to see them about mental health, even if they make out it is not a big deal, is probably suffering quite considerably.
I wonder if my hub had explained more honestly the extent of his illness, or if any of the Drs he saw had taken it more seriously, if he would be quite so sick now. But I guess there’s no point thinking about what might have been. All I can do now is share our story in the hope that by naming these issues it will help make things different.
Her own blog exists in the hope her writing will help her cope and help others supporting a loved one with a long term mental illness. You can read more at hubbydepressed.wordpress.com. You can also follow her on Twitter, where she's @hubbydepressed. We have kept her identity private, as per her wishes.