When Matt Rudd started writing about his midlife doldrums, he was overwhelmed by other men sharing similar experiences. One tragic story has stayed with him ever since.
Towards the end of his life, Mark Hanson made copious notes to himself. He was acutely aware that his spiralling thoughts about money and his preoccupation with worst-case scenarios were harmful. He also knew that comparing himself to others only deepened his unhappiness. The notes were his way to remind himself of these facts. At times gently encouraging, at times more reproachful, they could have been written by any number of the men I've spoken to over the past three years. In a ten-point list entitled "Ways of Reducing Panic About the Future", Mark began with "Count your blessings", "Enjoy the now" and, quite specifically, "You've virtually paid the mortgage on Wilmslow". For point number nine he wrote: "Stop comparing yourself to others — everyone has their own shit."
To his friends and work colleagues, Mark was an outgoing, sociable, driven man — the definition of success. In his own eyes, he was rather less than that. After disappointing GCSE results, he knuckled down and aced his A-levels. He was the first member of his family to go to university, but never forgot how close he had come to failure. That fear of failure continued to stalk him as he forged a career in communications. He struggled with low self-esteem and agonised about what might happen if he lost his job. It didn't matter that he'd already bounced back with relative ease from two previous redundancies or that his career progression featured more ladders than snakes.
Mark took his own life in March 2011. He was 36 years old, four years into a happy marriage and, by any reasonable measure, on the fast track to emotional and financial security. He had almost paid off that mortgage on the house in Wilmslow. He and his wife, Clare Francis, both earned decent salaries. They had relocated to Cheshire to be closer to his home town and they were planning to start a family. But in the end, the physical evidence of Mark's success was insufficient to overcome his own far less generous perception of himself.
According to NHS figures released before this pandemic year, one in five women suffers from anxiety or depression, compared with one in eight men. Yet men are three times more likely to take their own lives. Attempts have been made to explain this apparent incongruity by linking men's relatively high suicide rate to their tendency to resort to violence in general. This may be true, but it is only part of the picture. The fact that men are less likely to admit to — and seek help for — mental illness is also a contributing factor. From the first time a boy is told to stop crying and "be a man", the expectation is clear: men must be strong and stoic. They must not ask for help. To ask for help is to admit weakness, and weakness is failure in itself.
"Male anxiety and depression present in a completely different way to women, and it's a scandal how this means they are all but ignored," Martin Pollecoff, chairman of the UK Council for Psychotherapy, explained in an interview with The Times last year. "If you look at the Diagnostic and Statistical Manual of Mental Disorders, which is the bible for diagnosing mental health conditions, there are 800 pages of symptoms women will readily recognise because they express feelings, but few for men, whose behaviours under stress can be quite displaced.
"It's a terrible thing to say, but women feel and men act out," Pollecoff said. "They slope off to the pub, smoke a joint, start a fight, see a prostitute. Anxious men tend to lose themselves. And then the awful thing is, their anxiety is not diagnosed and we end up in this terrible situation where the first time we know something is wrong is when they take their own lives."
The impact on mental health of this intense and stressful year has still to be fully gauged. Data from various higher-income countries suggest that there has not been an increase in suicide rates since the start of the pandemic. This is expected to change. As a report in the British Medical Journal put it last month, changes will be "dynamic". "Evidence from previous epidemics suggests a short-term decrease in suicide can occur initially — possibly linked to a 'honeymoon period' or 'pulling together' phenomenon," it said. "We must remain alert to emerging risk factors for suicide but also recognise how known risk factors may be exacerbated — and existing trends and inequalities entrenched — by the pandemic."
Research from 87 Percent, a digital platform that monitors mental health in UK employees, shows rising levels of anxiety, loneliness and fatigue. In the six months before the second lockdown the anxiety spike was most acute in the 36 to 45 age range and for men more than women.
Last month Dr Adrian James, president of the Royal College of Psychiatrists, warned of an escalating mental health crisis. "As a result of Covid we are now seeing an increase in people attending emergency departments and presenting to crisis mental health services," he said. "We're also seeing an increase in the numbers of people, but also in the severity of their disorder, and this is a very common thing that is being reported up and down the country."
Even in normal times Christmas is a mental health challenge for many people. Study after study indicates spikes in financial stress, alcoholism, relationship issues and loneliness over the festive period. At the heart of it all lies that most pernicious of human conditions — the urge to compare ourselves to others. We are bombarded with other people's seemingly perfect baubled lives and it is even easier than usual to feel like a failure. For obvious reasons this Christmas will be different. Pandemic pressure and festive pressure combined. 'Tis the season to look after loved ones.
The good news is that the stigma around male mental health is slowly dissipating. Even in the two years since I first wrote about unhappy men in this magazine, it feels as if the conversation has shifted. Now I have mail bags — male bags? — full of men showing their vulnerability, being honest about their feelings, asking for help. In almost every case it was the first step that they found the hardest — to admit to their nearest and dearest that they were struggling. Some men struggled to admit it to themselves. They worried that just by thinking about "this stuff", the whole house of cards might come tumbling down. "I knew I wasn't happy, but I thought it was safer to opt for the fingers-in-ears approach," one correspondent explained. "I was still functioning as a worker, a husband and a father. If I started examining what was really going on, I risked all of those things which felt irresponsible." Fortunately, he took the risk. He took that first step. His house of cards did not collapse.
There have been men who found it easier to write to me, a total stranger, than talk to their family. I can understand that. I wrote a book about mental health because writing is easier than talking. These men were afraid that wives, partners or friends would interpret their struggles as failure. Instead, they were rewarded with understanding and support. The truth is that it takes bravery to admit you're struggling.
We have some way to go before the cliché that men don't talk no longer applies. And further still before this starts to have a positive impact on mental health. Because talking might be the hardest step, but there are more steps after that. How do you work through your anxiety? How do you break the cycle of depressive thinking? How do you silence the persistent voice in your head telling you you're going to stuff things up?
Mark had taken the first step. He had shared his struggles. In the hard years since Mark's death, Clare has tried to understand what it must be like to suffer with depression and anxiety, working with the mental health charity Mind and as a trustee at the Money and Mental Health Policy Institute. She has tried to answer the unanswerable.
"One thing I have learnt — which, unfortunately, I did not appreciate while he was alive — is just how exhausting it is to cope," she wrote a few years ago. "Not only did Mark manage to function and pretend all was fine, even when in a deep depression, he also had an inner battle going on inside his head all day, every day."
Today, as Clare shares Mark's notes with me, she explains her goal has always been to help people make different decisions from the one he ultimately made. With hindsight, you can read pain and suffering between the lines. Without hindsight, it is difficult to distinguish Mark's remonstrations with himself from those of countless other men at his — my — stage of life. He felt the pressures of responsibility, of being successful, of not failing. He had to remind himself of the good things in life. He had to reassure himself that everything was OK. He was his own worst critic . . . but aren't we all?
"I called him the squirrel," Clare says. "He'd regularly manage to save a few thousand pounds here and there. He had a decent salary — not six figures or anything — but his relationship with money was very different from mine. He didn't have a lot of clothes, but those he did have were designer. He could seem extravagant, but then he always took a packed lunch to work and he knew where to find the cheapest coffee in town.
"None of these are necessarily bad habits, but money occupied Mark's mind. He had a bath most nights to help him relax — he had trouble sleeping — and he would call out to ask how much money we owed on our offset mortgage or how much we had in our savings. I used to laugh. I didn't realise the severity of the situation."
As Clare points out, organisations such as the Money and Mental Health Policy Institute focus on people whose depression is linked to financial difficulty. Such cases — involving problem debt, long-term unemployment and accompanying insolvency — are visible, so they can be addressed. By contrast, Mark had no reason to worry about money so his problems remained hidden, but they were no less debilitating.
"He didn't talk to friends or family," Clare says. "He was scared that people would think less of him and would see him as weak. Even with me he held a lot back. He did this to protect me, he said. He thought I would find it too upsetting."
This doesn't mean that Mark was not trying to get well. "He did so much to try and tackle his illness," Clare says. "He had regular counselling sessions, cognitive behavioural therapy and acupuncture. He changed his diet and did more exercise. And he was constantly reading, trying to find something that might work for him. In his notes he talks about trying to 'crack the code' or 'break the code'. He believed — or at least hoped — that there would be something that could make him feel better.
"Ultimately, I think that's why he decided to take his life. He was trying to beat his depression rather than accept it and find a way to manage it. He got to the point where he realised he couldn't beat it. Either that or it all just became too exhausting."
It is upsetting to think about what Mark went through as his anxiety closed in on him. He was searching for solutions, but doing it largely alone, and alone the odds were stacked against him. Of course, there are measures we can take to reduce stress and anxiety. Many of the men I've spoken to have done just that. They've found a way through. That way might not be perfect. It might be little more than a distraction. Any one of a host of tricks and life hacks might help. You can start running. You can try yoga. You can download a mindfulness app. You can read a book by someone who used to be in the SAS who says things like: "Failure isn't making the mistake … it's allowing the mistake to win."
But Mark's messages to himself are often imbued with this sort of positive thinking. "Be happy with yourself and you'll perform well," he wrote just two months before his death as he reviewed a working day. "And I did, pretty much — 7/10. Didn't worry I wasn't saying much. Didn't blurt anything out or bottle it. Felt good at the end."
By urging himself to reframe his thoughts, to stop spiralling, to be kinder to himself, he was following the playbook of the self-help industry. And it didn't work.
Mark had grown up with all the typical patriarchal expectations of the modern man. If he lost his job, he lost his status and, with it, what it means to be a man. His rational self knew that this was untrue, but as Clare says: "His insecurities all too often overpowered him." Even in his final letter, he was worried about how other people would perceive him.
Mark's notes to himself are deeply upsetting because they are recognisable. Who doesn't lie awake at night worrying about the mortgage? Who doesn't decide, sporadically, that today is the day to get on top of everything? Who doesn't read the online article "Ten ways to change your life for the better . . . NOW!", scoff, then decide you'll have a crack at three and seven?
For Mark, his notes were just sticking plasters over a deep wound. His attitude to his own self-worth was set, as it is for all of us, in rigid, formative ways. Without a radical overhaul of the way we raise boys and the way we measure success, the mental health statistics will continue to look bleak and there will be more tragic stories to tell. That radical overhaul is not as improbable as it sounds. We are already on the right path. We have taken the first step. Men are talking. Men are rethinking what is important. In some ways this very difficult year has accelerated these conversations. The hamster wheel has stopped just long enough for many of us to reassess — and that can only be a good thing.
It is also true that this generation is one more evolutionary step away from those ridiculously repressed Victorians. The next generation — our kids — has moved further still. I am constantly and pleasantly surprised at how open my three sons are about their own mental health. They really don't find it embarrassing to talk about this sort of stuff — with each other, with their friends, with us — which is amazing.
Clare, meanwhile, has turned her grief into a laudable determination to help other sufferers. She relives her own darkest days in her efforts to raise awareness. But she accepts that some questions will never be answered. "I'll always wonder if things might have been different if Mark had been able to talk to a friend or tell someone at work," she says.
"If onlys" are the cruellest aspect for those left behind. If only Mark had talked to a friend. If only men talked more in general. That's step one. But step two — what do we do if and when men open up? — is more challenging. When men have dropped their guard in interviews, I've found myself reaching for solutions. I want to magic-wand their problems away. To a friend with a heart problem, still commuting to the job he hates: "Stop getting on that train. Take some time off." To the financial consultant who hides in the bath and likens his four-hour commute to a psychological waterboarding: "Stop hiding in the bath. Talk to your wife. Change jobs." To Mark: "Don't do it. Be kinder to yourself."
All of these quick and easy solutions go in the same box as jogging, yoga, meditation and not checking your emails in the evenings. They treat the symptoms, not the disease. They are to midlife misery what Nurofen is to backache. Fine in the short term, but not the same as ten sessions with an osteopath and a complete rethink on posture. What I have learnt is that it helps to share your worries. A problem shared is not always a problem solved, but it's comforting to know you're not alone. The more we talk, the less we isolate. The less we isolate, the more we can put those negative thoughts into perspective.
Isolation is very much the buzzword of 2020. All of us have experienced it to varying degrees. Kids have found themselves in bubbles, unable to roam as free as they should. Students are travelling home from a term confined to barracks. The rest of us have tried to adapt to a socially distanced existence. What makes a hopeful note at the end of this bleak story is that it doesn't take a lot to break that isolation. We can talk and listen and help each other. That's what we should be concentrating on as we all prepare for the bubbles and Zooms of this very special Christmas.
Adapted from Man Down: Why Men Are Unhappy and What We Can Do About It by Matt Rudd.
How to help a struggling partner
Symptoms of mental health problems can vary considerably from person to person, but some common warning signs include: becoming more withdrawn, irritable, hopeless or pessimistic, self-critical, disorganised or forgetful, eating or sleeping more or less than usual and losing interest in things that normally give pleasure. New research from Mind suggests that men don't feel as able to open up to friends or family as they do with their partners. This puts partners in a strong position to encourage men to take the first steps towards better mental health. It takes a lot for someone to say "I need help", but it doesn't hurt to raise the subject yourself.
Listen and empathise
You don't have to be an expert to help someone who is experiencing a mental health problem. Asking your partner "How are you feeling?" and listening non-judgmentally can make a big difference.
Ask how you can help
Your partner may already know how you can support them — for example, by going for a walk with them or supporting their hobbies. Checking in with them and asking how they prefer to be helped can help them feel more in control.
Encourage them to get support
If your partner's mental health is negatively affecting their day-to-day life, encourage them to seek help. This could be through their GP or a support group run by a local Mind.
Where to get help:
• 0800 543 354 (0800 LIFELINE) or free text 4357 (HELP) (available 24/7)
• https://www.lifeline.org.nz/services/suicide-crisis-helpline
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757 or TEXT 4202
• NATIONAL ANXIETY 24 HR HELPLINE: 0800 269 4389
If it is an emergency and you feel like you or someone else is at risk, call 111.
Written by: Matt Rudd
© The Times of London