“Why Would I Need Help?!” – On Men, Madness, and Mental Health

There was a time I fully believed the ad agency I owned with my wife had become a front for a secret porn empire she was running. I was also pretty sure my kids were replaced by shape-shifting aliens and government satellites were monitoring my every move. There was nothing anyone could do to make me believe otherwise. Nothing you could say to convince me to seek help. Long-term cocaine use had fractured my brain and was causing paranoid delusions and psychosis. But you couldn’t tell me that; I didn’t think I was psychotic, I had never been psychotic before, therefore, by God, I wasn’t now! Why would I need help?

It wasn’t until many months later, when I was homeless, divorced, broke and broken, that I began to understand the truth of what had happened. It took a loss of everything, and even then, acceptance was slow, agonizing, and definitely not linear.  As I look back now, I wonder, was all of that inevitable? When a man fully believes he doesn’t have a problem and he doesn’t need help, is there anything that family, friends, or the mental health system itself can do to save him from himself?

Men, especially middle-age men, are tough customers when it comes to accepting mental health help. Men’s Health magazine recently addressed this phenomenon in a special issue devoted to bringing light to a wide range of mental issues that many men would rather die than talk about – literally. Facing an addiction and getting help is difficult, but it’s a concept that’s much more palatable for men than mental health problems they are ill-equipped to discuss. Depression? Anxiety? Bi-polar disorder? Forget about it!

It was like that for me, and I’ve since learned, for many others. I was willing to consider that, yes, I was doing too much cocaine, and yes, it was affecting my life in some negative ways. I’d been to treatment before and it worked. I had over 5 years sober. I thought, fine, I’ll get cleaned up again, that’ll fix everything. But NO WAY did I need any kind of additional mental health help! That seemed infinitely worse somehow than getting treatment for an addiction. I would not and could not accept the possibility; I rejected it out of hand. Plus, I thought, there’s no help for that; you don’t come back from crazy! So, it just wasn’t an “option” for me.

It wasn’t an option, until all other options had vanished, and I had to face that I wasn’t the one calling the shots in this situation. If I’d had the flu, I’d have seen a doctor. If I’d had a chronic physical disease, I’d have taken care of myself with a treatment plan. But I only sought mental health help – from the UCLA Medical Center psych ward to be exact – when I’d run through all other possible options.

I’m far from alone; total avoidance of mental health talk (much less action) is much more the rule for men than the exception. And that makes reaching them with messages about how to get help exceptionally hard.

Complicating that landscape is the fact that mental health problems can look different in men than women, and therefore may be harder to recognize. Take a mood disorder, like depression. According to the National Institute of Mental Health, men’s depression can present as anger, defensiveness, irritability, and feelings of failure. It can hit us as physical symptoms like a racing heart or a tightened chest. Often neither the men or their partners recognize these symptoms as depression. Men have a tendency to self-medicate these symptoms with drugs or alcohol. And, even when a man does begin to think he might possibly need professional help, then comes the difficult question of how to approach it with his employer and what to say to his peers.

The pressure becomes a time bomb; a man will deny and internalize the problems, become even angrier at any suggestion he may need help, alienating his family and spinning further into isolation. The idea of suicide becomes a viable option, and for increasing numbers of men, becomes their final “solution.” Men are literally dying from their rejection of mental health help.

So is there anything family, friends, and the mental health system can do to intervene; to  reach a man with messages he can hear at the time he needs them; to deter a man from his own worst impulses? Can anything get through?

From my own experience, I don’t know of anything that could have reached me at the time of my breakdown. Some of us have to lose everything before we can see what is right in front of us. Or maybe I should say, before we can see what is so obvious to everyone else. For me, the loss of everything was one of the most important symptoms of my psychosis. I’d always been a successful high functioning drug user. Waking up homeless and broke on Santa Monica Beach, over 2000 miles from home, offered a terrifying shock to my psyche and ego. Something was going on in my brain that I didn’t understand. This was the beginning of a journey back to sanity that took years.

I don’t have the answers to this age-old problem of men and madness. But I do know this: Persistence matters. The messages matter; they sink in over time. If you’re a mental health marketer, keep sending the messages; stay on brand. If you’re a regional provider of addiction treatment for men in your area, keep sending the message. Use all the social media channels you can manage. Use traditional advertising too, if you have the budget.

If you offer a suicide prevention hotline in the community, make sure everyone has the number running through their head. Make it easy to remember with a jingle or a tagline. Start a high-profile community event, like a 5K race, that boosts awareness of the hotline number. These little marketing tricks work in helping imprint information on the brain. They can help a family member or a struggling patient retrieve it when they are in a tough spot. Access to mental health service is already hard enough. Mental health marketers should do everything we can to make it as easy as possible.

For me, everything coalesced on that California beach back in the summer of 2012 – things people had tried to tell me, information I’d rejected – in that moment that I was ready to reach out for help, it all came back to me. The messages hadn’t fallen on deaf ears after all. I don’t know what UCLA’s awareness campaign or marketing efforts were at that point, but I know that whatever it was, it reached me when and where I needed it, and I checked myself in to the UCLA psych ward. That kick-started the long journey to wellness. Kudos to UCLA’s marketing team for being at the right place at the right time with the right message.

Stay connected to the community; keep doing the public awareness campaigns; keep shoring up the families. When a man is ready to hear, when he finally has no choice but to hear, if he becomes ready to hear, your messages of hope and help and redemption will be waiting for him.

I’m living proof of that.