For the boys

Mental health – Men in crisis

May 21, 2023 Word for Word Media 0Comment

Dr Chris van den Berg expands on the mental health of South African men.

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My own awakening about the mental health crisis in South African men happened when viewing a statistic: an average of 14-18 South African men die by suicide every day. This rate is amongst the top 10 highest in the world.2 Four out of five suicide cases are men. In males under 45 years, suicide is the second most common reason for death, while in males between 45 and 64, it’s the sixth most common reason.

Many men are struggling emotionally and they often battle to speak up about it. With suicide rates this high, imagine the impact of mental health on health, careers, relationships, and general well-being.

A different presentation of male depression

Depression and anxiety in men are often missed, as it sometimes presents differently or is masked in such a way that it doesn’t look like depression. 

Depressed men aren’t always visibly sad, but rather become irritable and short-tempered, having anger outbursts or they become more silent and withdrawn. Increased substance use and other forms of escapism (workaholism, sport, gaming, pornography) are common features of men with depression. 

Even if sad feelings aren’t present, it doesn’t exclude depression: anhedonia (an inability to feel pleasure in normally pleasurable activities) is an often-missed symptom of male depression.

Myths that need to be busted

Myth: Feeling sad or anxious isn’t a manly emotion. 

Reality: Sadness and fear are primary emotions all human beings experience. 

Myth: Depression is a sign of weakness. Being depressed or anxious means that you haven’t tried hard enough.

Reality: Major depressive disorder is a medical disorder and it doesn’t discriminate. 

Myth: Depression can be overcome with enough personal effort and willpower.

Reality: All your best efforts might not be enough; it requires a holistic integrated approach to treat mental health conditions effectively.

Why do men struggle to ask for help?

There are multiple reasons including stigma, accessibility challenges, financial restraints, minimisation and lack of recognition of mental conditions in men. But the factor probably playing the biggest role is society’s script for real men: be tough and self-reliant. To be a self-aware, emotionally-attuned man who is willing to reach out if he is unwell, feels like weakness and failure for most men.

The Man Box

Studies3,4 on young men’s attitudes, behaviours, and understandings of manhood have used the concept of the Man Box to describe a set of beliefs, communicated by parents, families, media, peers, and other members of society, that place pressure on men to be a certain way. 

These pressures tell men to be: self-reliant; act tough; be physically attractive; stick to rigid gender roles; be heterosexual; have sexual prowess; and use aggression to resolve conflicts. Most men who adhere to the rules of the Man Box (those who most internalise these messages and pressures) are more likely to: put their health and well-being at risk; cut themselves off from intimate friendships; resist seeking help when they need it; experience depression, and to think frequently about ending their own life.

Another study5 found that one characteristic of masculinity stood out as a risk factor for suicidal thinking: self-reliance. It’s a lose-lose situation: the more one is inside the Man Box, the higher the chance of having mental problems and the smaller the chance to get help for it.

Cancer shakes the Man Box

It’s a known fact that a severe or chronic medical illness is a risk factor for depression in all people. For men, there might be more reasons why a cancer diagnosis could be devastating. When a man gets cancer, it could potentially threaten the safety many men find inside the Man Box. 

It’s difficult to be self-reliant if the cancer can’t be controlled, when you’re dependent on medical treatments to get better and you can’t be the main provider anymore. The cancer or its treatments could reduce physical strength and make you feel less than tough. Physical appearance and sexual functioning might be affected adding to a feeling of not being ‘man enough’.  

It’s okay (for men) to not be okay

“It’s okay to be not okay” is the message from Dan Reynolds6, lead singer of Imagine Dragons. When men can accept that struggling emotionally doesn’t make you less of a man, it paves the road for recovery. Help in different forms (medication, talk therapy, lifestyle changes, social support groups) is available. And getting help isn’t only for yourself, you’re doing it for the loved ones who need their man/dad/friend/colleague to be emotionally well.

I suggest men use the positive qualities of self-reliance (ability to navigate situations using resources, decisions, efforts, and abilities) in their favour, by reframing seeking help as something within their control, a way to take charge of their own mental health.

If you are in need of help, contact 0800 456 789 or visit


Dr Chris van den Berg is a Stellenbosch-based psychiatrist in private practice.

MEET THE EXPERT – Dr Chris van den Berg

Dr Chris van den Berg is a Stellenbosch-based psychiatrist in private practice.

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