Suffering in Silence: Men's Mental Health in America Today googletag.pubads().collapseEmptyDivs(true);

Suffering in Silence: Men’s Mental Health in America Today


Mid-way through my freshman year of college, the girl that I had longed to be with for years was nearly killed in a viscous, ice-slicked car wreck that claimed two other young lives. I sat, trembling, on my best friend’s bed, talking haltingly to her on the phone as she lay in a hospital bed, hundreds of miles away, nearly completely blitzed from painkillers and sedatives. I told her that I loved her, and she said it back. That’s what happens when you drug people, I guess.

I had been messed up for a long time — awash in anxiety and depression — but you need that tipping point, I guess, to motivate you to stand up and do something about it. I don’t know what I was hoping to find in that therapist’s office, under the couch cushions or in the tissue box or between the hands of the fifty-minute hour clock, but I knew something had to be there: answers, or at least different questions. The receptionist set me up with an appointment and she said to me, “You know, we do have a back entrance you can use.” I was puzzled.

“What’s wrong with the door I came in from just now?”

“Oh, nothing — nothing,” she sputtered, “We just offer it so students will feel more, well, comfortable.”

I walked out with my little appointment card thinking she must have hit her head on the kitchen counter that morning or something. What did it matter which door I used to go to the health center? At nineteen, I wasn’t smart enough to fully comprehend the stigma of mental illness, a stigma so powerful that even well-meaning mental health providers perpetuated it, by offering an anonymous entryway you could slink in through, concealed by hedges and secrecy.


Of course, I know now that there is a stigma surrounding mental illness and the stigma is far greater, in my opinion, if you’re a man. Think of all that the word “man” implies: strength, power, stoicism, assertiveness. Men aren’t supposed to have mental health problems. We are judged and pigeon-holed (in similar ways that women are).  I think it’s possible that this stereotype was much more pervasive years ago, when it was more of a pull-yourself-up-by-your-bootstraps, boys-don’t-cry, be a man, quit yer bitchin’ kind of society, but sometimes I think that not much has changed.

I remember being in kindergarten, one story time, and being particularly unsettled by a picture of a large spider in a book. Logically, I went and hid under a nearby table. Mrs. Pearlman wasn’t having any of it. “Oh, Gabriel,” she said disapprovingly, “Don’t be such a sissy.” Now, I don’t mean to pick on Mrs. Pearlman, who was actually a wonderful teacher whom I loved very much, but those kinds of things, obviously, stay with you. I have a funny feeling that, had I been a Gabriella instead of a Gabriel, she wouldn’t have said that. “Gabriella,” she might have said, “you don’t have to be afraid—come back and sit with the rest of the class. And, the next time you see a picture of a spider: be more assertive.”

An art project I made in Mrs. Pearlman's class.

An art project I made in Mrs. Pearlman’s class.

I joke because, sometimes, I don’t know what else to do. Of course, the stigma against men’s mental health is not funny. When you are told that it is not appropriate to talk about your feelings, when you have limits placed on what is okay and what isn’t okay to talk about, when you are expected, or when you expect yourself, to just shut up and deal with it, the consequences can be deadly.

According to data from the American Foundation for Suicide Prevention, for years, four times as many American males killed themselves than their female counterparts. In the Jewish faith, when you go to sit shiva with the family of the deceased, you are supposed to offer the greeting, “We suffer in silence.” It is indeed disturbing to think about how many men throughout this country and this world went to their self-inflicted deaths suffering in their own stifling, suffocating silence.

In spite of being warned against the lifelong perils of Sissydom by the well-meaning Mrs. Pearlman, I grew up to be an introverted, emotionally delicate, eccentric adolescent, and the guy in his mid-thirties who’s typing these keys right now isn’t much different either. I’m still not crazy about spiders, (and flying, and math, and socializing, and drinking, and work, and money, and aging, and getting dementia, and dying), though I have amassed sufficient coping skills to avoid the necessity of cowering underneath tables. Most days.


And in spite of the fact that openly talking about your mental health problems as a man is still regarded as a big no-no, I am pretty garrulous about what goes on inside that fetid bird’s nest inside my head. It’s not because I’m some great mental health advocate or some kind of big deal, I think it’s because I know that I am not smart or capable enough to sort out everything that’s going on up there myself. I think it’s because my mental health scares me very badly, and when you’re scared very badly, the last thing you want is to be alone.

Talking to people — to my wife, to my friends, to my family — actually helps me gain a little bit of perspective sometimes. Talking to people helps me gain a greater awareness of my distorted thinking, my impulsiveness, my crippling fears and my, at times, consuming nihilism.

I’ve been seeing a therapist for around five years. Depression, anxiety, compulsive behaviors, obsessive thoughts — the words and the diagnoses and the labels really don’t matter. They change them all around every year anyway, so they can justify having a big swanky conference. In college, I went to therapy once a week for two-and-a-half years. I never once used the back entrance — again, not because I’m a “Mental Health Hero” but because there is no reason not to go through the front door, just like the kid who’s there for a sore throat.


As an editor for OC87 Recovery Diaries, I think a lot about the personal essays we publish here, and I was thinking about the authors who write those personal essays, and those authors, overwhelmingly, are women. And that’s fine, as far as that goes, and they are an extraordinary collection of authors, but I started wondering to myself, “Where the hell are all the men out there struggling with mental illness?” I spent five years working in an inpatient crisis psychiatric hospital, so I know that there are plenty of men dealing with mental illness and, after several years of running creative writing groups at that hospital, I know many of them can write, too.

So then I started thinking: if just being a man with a mental health challenge is taboo — being a man with a mental health challenge — and writing about it publicly — must be even worse. Is there some kind of understood “we don’t talk about it” code amongst men with mental illness? What are we trying to protect ourselves from, and why? Well, we’ve been doing it this way for years and years and years; quietly biting our fingernails off in the corners of our offices with the door closed, staring at the twirling and the whirling of the bedroom ceiling fan at 3:51am, and I think enough is enough already. It’s time to try something else. It’s time to write. It’s time to talk. It’s time to make it okay, or, trust me: it won’t be.

I have not been doing well recently. It’s not easy for me to say that, but, if I’m bothering to write a personal essay, why not make it personal? I’ve changed jobs twice in two months, and my anxiety is raging out-of-control in spite of efforts to medicate it and rationalize with it. My therapist, God bless him, tries his best to challenge my cognitive distortions, but I am very persistent — chronically negative, and relentlessly self-flagellating. I obsess over my failures, and I have lots to choose from, and fret compulsively over failures yet to materialize.


While I readily accepted the notion that I needed therapy many years ago, there was another hurdle to my recovery that I wasn’t ready to leap and bound over quite so energetically; and that was medication. I shouldn’t need that, I told my therapist. If I’m depressed, I reasoned, I wanted to feel depressed, because that’s obviously what I’m supposed to be feeling if that’s what I’m feeling. I became obsessed with trying to come to terms with what did it mean that I needed medication.

In my mind, needing therapy just means you’re neurotic. Needing medication means you’re sick. Men can’t get sick: they have to go to work. As a kid, I can remember my father going to work when he had a temperature of 104. He went to work immediately after having a major dental procedure, only to pass out in the bathroom from blood loss.

I don’t want to be sick.

My mother has become increasingly interested in my mental health lately. Maybe she always has been, but she was too afraid to talk to me about it, or maybe my issues were relatively benign years ago and didn’t necessarily warrant questioning or conversation. Lately, though, as I have been doing worse, she is spontaneously bringing it up more. I guess there’s a cause-and-effect there somewhere. I have to say, though: it’s nice. Even if I don’t always want to talk about it, it’s comforting and validating to know that she does, and she is respectful and backs off if I’m not in the mood to go there. I often said to her as a little boy, “Mommy, I think I should be in therapy.” And I should have been.


If my eight-year-old son called me into the living room to watch him ghoulishly re-enact the Pan-Am 103 bombing using rows of Playmobil men wrapped in Kleenex death shrouds, I’d sure as hell have been on the phone with somebody, but her response was always, “Therapy? Oh, Gabriel, wouldn’t you just love that?” I couldn’t believe my rotten luck: I was born into the only upper-middle class Jewish family in the country that didn’t believe in therapy.

She’s much different now, even if her only son isn’t so much. Now she is inquisitive and thoughtful, she really listens when I talk to her about therapy or medications, about how I’m doing at work and at home. It may very well be that talking to my mother isn’t going to change anything, but the dialogue is so desperately important, for both of us, I think.

So many times, mental illness tells us, “Go — run, hide! Shut everybody out. Go run down to the basement and throw a wool blanket over your head and stay there for about thirteen years. Tell them to leave you alone.” But mental illness tells you that because it wants to be your only bedfellow, your one true confidant — mental illness wants to be your mommy and your lover and your confessor and, of course, your undertaker, too.

That’s its ultimate goal, and isolating you from people who care is one of its most insidious tools. As someone who typically eschews forms of human contact other than his immediate family, my mental illness has a pretty easy time luring me away from others. When I’m not doing well, I’m perfectly happy to draw the shades and slide the chain across the front door’s lock at 7:30pm as I ignore emails from old, dear friends that have grown stale and unanswered in my inbox for another day. Or week. And when I’m not doing well, I have to work especially hard to remind myself that I need these people desperately.


Because while I’m not good at much, I have done a particularly impressive job at surrounding myself with some pretty wonderful friends — they are sensitive and empathic, intelligent and insightful, and beautiful in every possible way. And I’ll bet you have people like that in your pocket, too. People who are tuned in and available, non-judgmental and supportive. Maybe we just need someone to let us know that it’s okay. And I don’t think that message can be effective coming from a public awareness campaign or from a crisis line poster — I think it has to come from a person. A warm hand, a kind heart, an open mind.

This can be a nasty little world we live in, full of plane bombings and car wrecks, and spiders, too, and it doesn’t take all that much to tip the scales from manageable to just too much. Trusting your gut and paying attention may save someone’s life some day, or it may just make a certain man in your life at ease enough in his own skin to tell you even a fraction of what’s on his mind. And it may surprise you or haunt you or move you, but you’ll have performed one of the truest kindnesses one human being can offer another: availability.

That availability you give to another human being might just give him the courage he needs to seek the help and guidance of a mental health professional — walking through the front door.




EDITOR IN CHIEF: Bud Clayman | EDITOR: Glenn Holsten | DESIGN & LAYOUT: Leah Alexandra Goldstein

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Gabriel Nathan

Gabe is an author, editor, actor, playwright, director and a lover of commas. For five years, he worked at Montgomery County Emergency Service, Inc. (MCES), a non-profit crisis psychiatric hospital in the capacity of Allied Therapist and, later, as Development Specialist. At MCES, he created innovative programs such as a psychiatric visiting nurse program, a suicide prevention collaboration with SEPTA, and an Inpatient Concert Series that brought professional performing artists to entertain the patients and enrich their inpatient experience. While at MCES, Gabe also produced and directed a full-scale production of Thornton Wilder’s Our Town with the staff of the hospital, as an exercise in teamwork, empathy-building, and creative expression. Gabe serves on the Board of Directors of the Thornton Wilder Society and is Editor of its newsletter. He lives in a suburb of Philadelphia with his wife, twins and a basset hound named Tennessee.

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  • Patty

    Thanks so much for sharing! I wish you peace, joy & happiness more often!! I also hope and pray my teen son will heal from similar conditions and accept the help that is surrounding him that he resists!

    • Gabriel Nathan

      Hi, Patty, I really appreciate your taking the time to write. I, too, hope the best for your son, and for you as well as you help guide him along the way. We’re all only human, and can only accept help when we’re ready. Thanks again for reading, and writing.

      • Patty

        You’re welcome! I missed my calling; should have stayed in school for Psychology. I guess God decided to give me on the job training : ) Thanks for your kind words & well wishes! I appreciate great insight/information/articles, etc. like yours. Inspiring and informative…….

  • Berta Britz

    Gabe, you and your story are beautiful! Thank you for sharing your humanness and doing it with such beauty, humility, truth and humor. Those who know you, now including all the readers of OC87 Recovery Diaries, appreciate your gifts and talents–your generosity in creating a more loving world for all of us.

    • Gabriel Nathan

      Hi, Berta! Thank you so very much for your lovely response to the piece. I greatly appreciate your words, and your friendship.

  • Ruth Greenwold Deming

    I couldn’t have said it any better than Berta! Your candor is fantastic and will help other people – even men! – to speak openly about their struggles. AND you know how to post one helluva good story.

    • Gabriel Nathan

      Hi, Ruth,

      How very kind and thoughtful of you! I only wish I could have been even more candid– there is always lots that is left unsaid…

      Thank you for your comment.

  • BipolarMom (Jenn)

    Gabe I am so proud of you for sharing your story and inspiring other men to be brave and do the same. Mental illness is nothing to be ashamed about, and I applaud you for speaking out to let people know that men need to talk about their feelings and their mental health just as much as women do. You are a fantastic writer and editor and I’m certain you’ve inspired many men to consider opening up and sharing too.

    • Gabriel Nathan

      Jenn! So wonderful to hear from you. It was a pleasure working with you as an editor on your piece and I hope we can work together again. The more we talk, whatever our gender, the better it is for all of us.

    • Russell

      Hi Jenn. I don’t think men need to more brave. I think society needs to be more compassionate and empathetic to men.

  • CPatrick McIlvain

    Good afternoon Gabe, Great article! I see a lot of me in your personal story. And for someone who states – “while I am not good at much” you seem to be very good at sharing your feelings and awareness and a lot more. Oh how our mental illness (our self talk) can really pull a distorted veil over our own eyes so what we see is very often not the real truth at all. I have been battling depression along with a couple of other mental illnesses for most of my life – so true men have a very difficult time sharing about our battles – as the age of 60 (after many years of therapy & still going) I acknowledged that I was strong enough to be a voice for my brothers & sisters who have not yet realized that we are all born winners and thus do have a right to have one’s voice heard. I do my best to get the public to be actively engaged in having a #PositivePublicDalog when talking about mental illness out in the bright sunlight of day, just where the conservation. That is one of the reasons that I created The Walk for Mental Health Awareness – Houston.
    And I hope that more men will add their thoughts to this conservation.

    • Gabriel Nathan

      Hi, Patrick,

      Very nice to hear from you, and thank you for calling me out on the “while I am not good at much” line. It’s amazing to me how those things we tell ourselves slip very insidiously into conversation and prose. You sound like you have been doing a lot of great work on yourself and I’m glad that you are helping others. These are conversations that need to take place and I’m proud to be a voice that’s speaking up. Thank you for doing so too.

  • driversuz

    As a male mental health patient, you are somewhat fortunate to be so well spoken, so “verbal.” Men generally are not comfortable talking about their feelings; they tend to be more comfortable “doing” about their feelings, or even just being in the presence of an understanding friend who won’t pressure them to “open up.” As a talker you have many resources (professionals) even if you didn’t have confidants among your family and friends. Too many people in the mental health field, and especially in the general public, are unaware of the ways most men naturally deal with emotional issues; they think it’s a flaw in masculinity that such men aren’t interested in, or helped by, traditional therapy. Mental health professionals have a duty to step back and try to understand why their current practices rarely serve the needs of men – without blaming the patients.

    • Gabriel Nathan


      Thanks very much for your feedback. I think there’s lots of blame to go around in the realm of mental health, but, on the whole, I think mental health professionals struggle valiantly to help people who are very, very sick who sometimes cannot or will not open up, and these same professionals are beguiled and confounded by illnesses the psychiatric community still does not fully understand, yet must treat anyway with the best tools available at the time.

      • As someone with a few decades in the mental health field, I have to disagree. And I respectfully submit that the blanket approach of getting everyone to “open up” is generally more useful to make therapists feel adequate than in addressing the needs of their clients.

        This is particularly true with men. While some of them may benefit from articulating their way to emotional catharsis, many men, most of them in my experience, don’t process and heal that way.

        Men tend to express themselves with actions vs words in many cases. When you have clients like that, and you pressure them with expectations to “open up” you are being unintentionally abusive.

        I suggest you read Tom Golden’s books on men, grief and healing to get a more nuanced, less cookie cutter understanding of the male psyche.

        • Thanks for the plug Paul. :>)

          I think that we have much to learn about men and emotions and one thing that is often missed is that men, when they do decide to open up, are usually met with a brick wall of indifference or worse. Much has been written about how men don’t want to talk about their feelings but very little is written about the fact that no one really wants to listen. People tend to run.

          The author is fortunate to have a mom who is able to sit with him in his difficulties. Often it is the moms who are the only ones who have compassion for young men’s emotional pain. (my next book is helping moms get close to their sons :>) …) They are impacted far less by what researchers are calling “Precarious Manhood” which describes the reality that men live in a world where they must prove themselves constantly.

          Men have been wonderfully creative in their ways to adjust to precarious manhood, the testosterone flood, male-male competition and more. Men are good.

    • CA, Belgium

      You’re right that therapeutic practices need to be adapted to address men’s problems more adequately. I’m not a mental health professional, but it has been my observation that men are often reluctant to see a therapist, even when they need one. The reason is that they are not comfortable with sharing their feelings with a stranger. Maybe the alarmingly high suicide rate can be (partially) explained by an inadequate therapeutic approach?

  • Liz Lalama

    Thank you so much for sharing this. One of my very good friend deals with mental illness and is a guy. I often wonder how much harder it is for him than for me.

  • Stephen

    So, I have depression and anxiety. I have gone through years of therapy, support groups and medication. It seems to me that this world is not very understanding of mental illness — so isolation comes from people not getting you or understanding what is wrong with you and judging you (not always the patients fault). Also, I have had some terrible experiences with doctors and MH professionals. I think that is more important to highlight. Nobody listens to you — what they do is rush you into treatment…hand you a bottle of pills and interrogate you with a bunch of questions. Then they say that all of your feelings are a lie and encourage you to not trust yourself. Pardon my language here, but the mental health system is really fucked up and terribly flawed. Add that to the fact that men are more likely not to open up and you have a mess. 😉

    • Gabriel Nathan

      Hi, Stephen,

      It is flawed, and there are incompetents and malcontents in the mental health field who are just there for a paycheck or because they couldn’t hack it as a surgeon or whatever the case may be, but there are also strong, intelligent, creative, empathic and resourceful individuals out there fighting for their patients every day– I have seen it, and I know it to be true. It is a struggle, sometimes, to find these people and connect with them, but you owe it to yourself and those who love you not to give up on “the system” and keep trying.

      • Stephen

        Yeah, logically, I know you are right. It just is very hard and to keep trying is exhausting. Some days you just want a place to go to that is safe and easy as a refuge, but instead you have to explain yourself and fight and search and it just gets so tiring. Also, depression/anxiety comes from different sources and finding those sources is intense work and takes a very long time sometimes. And a lot of times, therapists are not equipped to deal with that. Very complicated.

  • You nailed it. In so many ways, I can recognize myself in your writing. I have a blog that I write about my experiences as well. I would not have done it, say, 10 years ago, but at 53, you get to the point where you figure you have little to lose. And you are well spoken and do write very well. The real shame of this situation, ultimately, is all the great creations that won’t happen because of the stigma. A shameful waste of human potential. Hopefully we can help the future.

    • Gabriel Nathan

      Of COURSE you see yourself in my writing– your avatar is of Dr. Strangelove, for God’s sake! Pleasure to meet a kindred spirit. You’re quite right, though, about stigma being a barrier– stigma, shame, hate, guilt, fear– the whole lousy, stinking mess of it. But we cannot permit it, every day is a step forward.

  • Susan Lynn

    Thank you for sharing Gabe. There is a horrible stigma surrounding mental illness. I think you made a great agrument that it is even greater for men. My son before he passed was a mental health specialist in the army. These men in a particular who pride themselves in being strong and protecters are oftened shamed by the systems and their own minds if they seek help. Hence the very high rate of addiction and suicide in this population. My battle with depression and anxiety began pretty late I life. I always prided myself in being a resilient person having gotten family through some pretty tough times. And one day I’m nearly 50 and am so depressed I can’t get off the couch. Or am trying to make excuses to my kids why I just can’t go to the store because I’m to anxious to be out in the world. I remember at my worst the best thing for me was going to work cuz I had to function and I almost felt normal. On day I remember getting to work and a dear patient was just lying in the middle of the floor. And I thought how much would I want to lie there next to her and suck my thumb and cry. My depression and anxiety are not a debilitating as they once were. I see a therapist which helps tremendously. I guess I’d like to get to this day when it all goes away for good. But perhaps the greatest stigma is in my own head. I wish I had the answers. Susan