Men and depression – the courage it takes to fight this silent epidemic

Depression in men - it takes courage to seek help

Depression in men – it takes courage to seek help

Picture the worst person you can imagine whispering the cruelest things in your ear. Now picture yourself believing every single word. To try and get away from that person, you start isolating yourself from everyone. But that person is actually thoughts inside your head and they follow you around and the pressure cooker of feelings continues to build and build.

You feel like you’ve got no way out and that it would be embarrassing to tell anyone.

That’s what depression feels like for many men.

It robs them of joy, of connection with loved ones, of their own self-worth and physical strength. Worst of all, some men don’t even know this is called depression.

 

Why don’t men talk about depression?

Sadness, loneliness, despair and helplessness are likely to be taboo words for most men. That’s because when men have any vulnerable feelings they are often hit with a huge tsunami of shame that follows closely behind. Shame is created by the messages men get directly or indirectly about which emotions are acceptable and not acceptable. These beliefs are borne within a family, relationship, community, religion, culture and society in general.

How do men discriminate against themselves?

Men’s stories about their negative feelings sound something like this:

If I bottle it up, suck it up, just carry on, I’ll be right.”

“I am strong when I’m tough, independent and unemotional.”

“If I can’t tough it out alone, there is something wrong with me.”

 

These views form a centrepiece of self-stigma. It is how men add shame, embarrassment and humiliation to their emotional experiences. It acts as handcuffs for men, preventing them from reaching out for help and contributes to men not seeking support until their depression is very severe, if at all. It’s no wonder then that the biggest killer of men under 45 is suicide, that 1 in 4 men have thoughts about taking their own lives and that more than 40% suffer in silence, never telling anyone how they are thinking or feeling.

 

Meet Joel – the man behind the mask who had the courage to talk

Joel* was a 35 year old outwardly successful engineer who came to see me for help with his gambling and his daily marijuana use. His partner of 10 years had recently discovered his gambling and the loss of a sizeable amount of money. His relationship was now in crisis and they were considering separation. Joel was unable to open up and explain to his partner what was going on inside of him. Every time he went to look inwards he felt like a ‘cloud’ would come over him that left him confused, ashamed and at a loss for words.

Marijuana helped him relax in the evenings and gave him some relief from the negative self-talk that he was failure and that there was something deeply wrong with him for not being able to snap out of it. The more he hid and kept secrets, the more ashamed he grew of his behaviour as he knew he loved his partner and could see the impact of his actions but nevertheless, felt compelled towards these behaviours.

At the same time Joel was becoming increasingly withdrawn around his friends and partner, he also noticed he was getting more irritable over small things. When a stranger would brush past him on a crowded street, he became convinced that they were showing him disrespect deliberately and would become engulfed with anger and fantasise about ‘smashing them’. Joel began to feel that the world was acting against him.

So by the time Joel came to see me, the cracks in his mask were getting bigger and he was desperate to make a shift. This was Joel’s first ever attempt at talking about what was happening behind his mask with ANYONE – he had not spoken to any of his friends or even his partner about what was truly happening inside of him.

 

What does depression look like in men?

Depression looks different in men and women. In fact, in men who are deemed clinically depressed, some don’t even know they are depressed. All they know is that they have a stomach ache or headache that just won’t go away. They know that they hate their job and they have lost their mojo in the bedroom. Or they know that everyone keeps doing these little things to deliberately irritate them. Or they may know they have become obsessed with work or are turning to alcohol, drugs, gambling or sex to get some relief. Women at this point are more likely to say “I think I may be depressed”. Men, on the other hand are inclined to say “I am not depressed. I don’t want to talk about it. I’m just fine”.

What are the hidden symptoms of depression in men?

Angry and irritable – snapping at your kids, fighting with your partner, having road rage.

Work performance suffers – depression affects your ability to concentrate and your motivation.

Stress-related medical problems – headaches, back pain, irritable bowel syndrome, heartburn, recurrent viral infections, tired all the time, waking up in the early hours of the morning for no good reason, difficulty getting or maintaining an erection.

People feedback – people asking if you are all right, that they can sense something is wrong and that they are worried. Or they are telling you they can’t stand your snappiness.

Numb and shut down – you can’t feel your emotions, even when you want to feel. You don’t feel anything except maybe being annoyed all the time. Feeling empty and very disconnected from other people. For example, not being able to feel the joy celebrating big moments in your life, or not being able to snuggle up and feel close to loved ones.

Deep cover depression – these are the guys that look great on the outside – cheerful, got it together, successful, everybody likes them. But the outside doesn’t match the inside – you may feel miserable, broken or like a fraud.

Addictions/reckless behaviour – relying on alcohol, drugs, gambling, work or sex to take the edge off.

 

It takes courage to ask for help. You are not a hero if you suffer in silence.

Using a mindfulness exploration technique, Joel and I explored these feelings of shame, disgrace, humiliation; specifically how it felt in the body, what thoughts and beliefs were attached to them. Joel learnt to make room for these unfamiliar yet normal feelings and to give less oxygen to his shame by having them. He learnt to feel his feelings without reacting against them, and to give himself permission to express and communicate his emotions. He found that over time, his shame disappeared. He developed more tolerance, less judgment and more acceptance of himself. He began to see vulnerability as a great strength as it required him to have courage to face risk, uncertainty and emotional exposure. He found it took a lot more guts to be vulnerable than it was to stay hidden and embraced a new definition of what it meant to be “strong”.

Once enough shame had subsided, Joel was then able to learn how to stay and work with increasing amounts of discomfort rather than covering over, pushing away or distracting himself from it. By feeling his feelings in a mindful way, he discovered they were not so bad after all and he could manage them directly by attending to them kindly.

He was able to identify and examine unhelpful templates that he had downloaded from his own childhood and how they played out now in his adult life. From this mindful observer state, he became less reactive, less automatic with his reactions to the world and for the first time ever, he felt he had the choice to shape his reactions to life in the way he wanted them to be. In this way, Joel could re-write his own story.

After cultivating this self-compassion and way of seeing, Joel was able to see the underlying forces that drove him to marijuana and gambling and was able to deal with these feelings at the root source. His discovery of a new way of being in the world had a positive flow-on impact on his relationship with his partner as he now had the language and skills to describe his inner emotional landscape. He noticed he was able to self-regulate when he came across intensity or discomfort and could provide a much more positive presence for his partner that had never ever been there before. And as he liked himself more and more, other people also found it pleasant to be around him again.

*Name has been changed

By Dr Marie Paek, a medical GP and somatic psychotherapist at the Wholistic Medical Centre.

Dr Paek has formal training in a mindfulness-based, body-oriented psychotherapy.

mpaek@wholisticmedicalcentre.com.au

Panic attacks and traumatic stress may be helped with mindfulness psychotherapy

Stress blog pic

 

 

 

 

 

 

Panic attacks and traumatic stress may be helped with mindfulness psychotherapy

Sally* is a 50 year old woman who came to see me in Surry Hills after a month of having severe panic attacks. These started first thing in the morning. She experienced shortness of breath, tightness in her chest, racing heart, trembling hands and legs, nervous sensations in the belly, irregular breathing and a sense of suffocation and impending doom. Often there would be no trigger for these panic symptoms. They would be intense for around 30 mins then would persist in varying degrees all throughout the day.

These panic feelings were impacting her ability to work effectively and maintain a social life. Sally often thought during these panic attacks that she was “going crazy” and perhaps there was “something deeply wrong with her”.

Ordinarily, Sally was a highly competent, robust individual who had never really experienced any severe anxiety or panic symptoms. However, she had just been through a major life change – she had relocated to Sydney from overseas after leaving a highly traumatic and abusive relationship. This relationship involved experiences of feeling a combination of complete overwhelm, helplessness and fear. One of the coping strategies she had adopted was to “keep going and push through” with a focus on action- oriented outcomes.

There was also a past history of accumulated grief from her recent mother’s and her late husband’s deaths, which she admitted was still unprocessed within her. She was holding traumatic stress in her body.

Sally was interested in helping herself as much as she could. Although she came to see me as a GP, she did not want to use medication unless it was absolutely necessary; she preferred to turn to mindfulness psychotherapy to help her.

Mindfulness psychotherapy may be healing

Through our weekly sessions together, she learnt how to use mindfulness to slow things down and observe her internal experiences without getting completely hijacked by them. She learnt to build and discover resources within her body and mind that helped her panic symptoms. By understanding and learning how to calm her internal world Sally felt empowered to then begin processing and integrating her previous ‘undigested’ memories and feelings.

This process allowed her to make sense of what has been senseless before and to regard the feelings in her body as useful information rather than something to be avoided.

Sally now experiences significantly less anxiety. More importantly when the waves of anxiety do arise, Sally now can work with her internal states, rather than let them escalate into full-blown panic as it had before. Mindfulness psychotherapy has allowed her to witness her thoughts and feeling and get a gauge on how they impact on her body. By working directly with and navigating the information held within her body, Sally now draws upon “safe” places, both inside and outside the body to regulate her arousal and bring her back into the present moment.

She reports feeling less reactive and acting less automatically and can now make decisions based on choice.

How does mindfulness psychotherapy help panic attacks and traumatic stress?

Sally’s panic attacks were a reflection of traumatic stress stored and held within the body. As a whole, our bodies are highly intelligent systems, equipped for stress and even trauma. When there is a perceived threat, our bodies will instinctually activate our “flight/fight/freeze” mode to take action and respond to danger. This then leads to a complex biochemical cascade within our bodies that orients us for survival.

Ordinarily, we can usually cope with great stress for a period of time as long as it is temporary and/or we can make sense of what has happened to us. However, when we are faced with trauma, this survival response becomes frozen and our bodies are unable to discharge all the pent up energy. We keep re-living what has happened, even when there is no obvious threat – it’s like a bad tape that keeps playing over and over again, without an option to pause or stop. So by using mindfulness to slow down, we begin to examine more carefully what is happening and to take in new information that would otherwise have never been noticed or would have been dismissed. We learn to develop a new language for reporting on our own internal experiences and finally begin to get to know intimately our emotions, thoughts and beliefs that held us captive for so long.

* Name has been changed

This case study is for educational purposes only. Results may vary due to individual circumstances.

Dr Marie PaekGeneral Medical Practice, Mindfulness Psychotherapy

For more information see:
www.hakomiinstitute.com
www.hakomi.com.au

“What does this nausea in my stomach and tightness in my chest mean? ”

What does this nausea in my stomach and tightness in my chest mean

 

 

 

 

 

 

Chest tightness can stop a person from breathing deeply

Michelle* was in her late 40’s when she first came to the Wholistic Medical Centre. For the previous five years she had an upset stomach, felt nauseous every day, had some bloating after meals with bouts of diarrhoea alternating with constipation. She had been advised to reduce grains, dairy products, sugar and caffeine. She followed that advice and lost 11.5 kilos. The abdominal discomfort reduced a little but did not disappear.
In the previous few months Michelle also noticed a discomfort in her chest. It was so tight that it stopped her from breathing deeply and even prevented her singing. Given that she was a singer, this had become quite a serious limitation. Further medical investigations revealed no abnormalities in her digestive or respiratory systems.

Michelle felt that she couldn’t do anymore with her diet or medication and she suspected that there might be an underlying emotional problem that was behind all her symptoms. She chose to work with a mindfulness based psychotherapy approach.

During her first session, she was guided to study her experience of tightness in the chest/throat and tightness in her abdomen. As she did this, in mindfulness, it became apparent that she had felt exactly the same feeling many times before. It felt like a strong fear. When asked to trace her earliest memory of that, she vividly remembered that at 13 she was made to sing at family functions and experienced ridicule from her cousins. In order to cope, she remembers tightening up her diaphragm and ignoring her feelings of shame and fear.
She was directed to imagine going to help her 13 year-old self: to appear in the family room and to go to her 13 year-old self in a kind and comforting way; to let her know she doesn’t have to sing if she doesn’t want to and to tell her cousins to sing themselves or to be quiet. Staying with that imagined new scene gradually produced a relaxation of the throat and abdominal contractions.

Those muscles relaxed all by themselves, as a new possibility was introduced: ‘I don’t have to go along with my family’.
Subsequent sessions revealed that feelings of fear were constant during her early home life. Sometimes after school, she would stay in the driveway outside her house, too afraid to go inside, because she did not know what she would walk into. Her father could be drunk and yelling abuse. Her mother could be either withdrawn or panic stricken.
Since her childhood she had learnt to ignore her fear and tighten her body in order not to feel it and keep going.

Over the next 5 sessions Michelle was able to go towards her ‘exiled’ feelings – they were allowed to come into her awareness and she was able to take care of them in a soothing way.
An important realisation was that she was so used to being fearful that she had concluded an existential belief of ‘I fear therefore I am’. In fact not feeling full of fear felt strange and empty, even though feeling free of fear was what she was seeking.
Once Michelle began noticing that belief in action she slowly began ‘digesting’ a new possibility of ‘I can live without fear’. This did feel strange and took some getting used to, especially as the fear would bounce back by itself. She would have to feel it and let it pass over and over again. Over 3-4 weeks the previous habitual states of fear and physical contractions gradually lessened, the abdominal tension stopped and her singing voice gradually found an open channel.
A new way of being in the world was now becoming a real possibility!

Discussion
The notion that feelings are ‘exiled’ from day-to-day awareness is fascinating. Our nervous system learns to actually shut out the unpleasant experiences from our consciousness for the purpose of getting through it. When there are no other choices and no support this is a useful ability to have had at the time.
However the underlying feelings persist in the body and the conclusions that were made based on those past events continue to influence current life. Conclusions like: ‘life is scary’; ‘I’m not quite good enough’; ‘nobody is interested in what I feel’; ‘having emotions means I have a mental health problem’ and so on, place profound limitations on our lives.
The use of mindfulness in psychotherapy allows an exploration into the emotional memories without re-traumatizing and without intellectualizing. The original pain is accessed and new more soothing experiences can be introduced. These new experiences allow new conclusions which are far less limiting than the previous ones.
In this precise and gradual way Michelle released her pattern of holding tension in her abdomen, chest and throat. She felt more at ease and confident within herself and as a bonus she became less angry with her children and more loving to her partner.

 

*Name and details have been changed. Results obtained by one person does not mean the same  can be expected by another. Each person has different life experiences and circumstances which will influence responses.

Dr Nick BassalGeneral Medical Practice, Mindfulness-Based Psychotherapy – Wholistic Medical Centre

emotions and physical symptoms

Releasing strong or ‘stuck’ emotions can relieve physical symptoms

 

emotions and physical symptoms

When our system falls out of balance due to stress or a hectic lifestyle, it often shows up as dis-ease in the body. But did you know that unresolved emotional issues can also show up as physical symptoms and sensations in the body?

Brian*, 35-years-old, came to see our naturopath at the Wholistic Medical Centre, complaining of fatigue, difficulty getting up in the morning, a sense of overwhelm at work and a general feeling of flatness. He had recurrent flu-like symptoms, a recurring sore throat and his libido had disappeared. He tried drinking more coffee to boost his energy, but he would crash a couple of hours later. What’s more, his symptoms had been getting progressively worse over the past two years.

Brian felt like his “tank was empty.”

He had blood tests to check for possible causes of his symptoms: examining thyroid function, liver, kidney, blood count, testosterone and cortisol levels, iron, sugar level and vitamin levels. Most tests were essentially within normal range with a slight decrease of adrenal cortisol in the morning.

Our naturopath recommended some dietary improvements: increasing his protein intake and cutting down on caffeine and alcohol, along with some herbs and supplements to support his adrenal glands.

At a follow up visit, Brian mentioned that he got some benefit from the dietary changes and supplements. He found though that after stopping coffee and alcohol, he experienced an underlying deep exhaustion. He also mentioned that he wanted to learn to better manage stress and to reduce his fear of failure.

He was referred for mindfulness-based psychotherapy, to explore his emotional wellbeing and further support a holistic approach to his health.

During Brian’s first therapy session, it unfolded that two years ago his father (who he had been close to) died from cancer at the same time that he started work in a high-pressure senior executive role and started a new relationship (which had ended 3 months ago).

During the session, he was guided to study his experience of exhaustion more deeply, from a position of neutral observation and without analysing or reacting against it. He observed a strong heaviness in his body that pulled him down. The sensation was familiar to him and was connected to feelings of sadness and fragility.

When Brian relaxed the contraction he felt in his throat, the tears that had been waiting to be released flowed out gently. He was guided to let go of the heaviness with each out breath.  To his surprise, the heaviness began to lighten and lighten and eventually, it disappeared.

Brian realised that his fatigue was not merely physical, but had a lot to do with unprocessed grief surrounding his father’s death and his recent relationship ending.

At the next visit, Brian explored the nature of his mental activity. He experienced racing thoughts that were a mix of self-criticism, fear and worry about future predicted problems and worry about his direction and success in the world. Brian was able to observe his thought patterns, without being drawn into them or believing them.

He continued to use the techniques of Self Dialogue he learnt during the sessions in his external life, to settle his mental noise and release his heaviness and sadness. Now Brian has learnt to use the memory of his dad in a positive way; he imagines listening to his kind words rather than avoiding thinking of him to avoid the fear of being overwhelmed by sadness.

A month after his mindfulness therapy, Brian’s sadness lifted, his motivation and excitement for life returned and he has now freed up mental and emotional space for a new relationship in his life.

What are the take-homes from Brian’s experience?

1)      Emotions are experienced as physical symptoms.

That’s right. It seems like an obvious one, but this is often overlooked. We feel emotions in our bodies; we don’t think them. Sensations felt in the abdomen, chest, throat, shoulders and neck and even the lower back can all have emotional roots.  Same as we experience body sensations such as hunger, thirst and tiredness –these are useful physical messages of our bodily needs that we have learnt to interpret and respond to accordingly – we also experience emotional sensations. They are equally intelligent messages that are a signal of our needs; however, we often wrongly interpret or deny them.

2)      Strong or ‘stuck’ emotions are often mistaken as physical health problems

Because there are thousands of illnesses but only hundreds of symptoms, making a diagnosis is not so straightforward. ‘Physical’ causes of illness also share similar symptoms to emotional causes. Tightness, heaviness, cramping pain and spasm can all be caused by emotional triggers.  Emotional symptoms fluctuate with emotional stress and are usually recurring sensations. When they become strong or constant, we often misinterpret emotional sensations as a physical health problem and seek help from health practitioners.

Medical practitioners are particularly trained to exclude serious pathology and therefore look for serious health issues. Tests are performed and if they come back negative, we can be left thinking, “It’s all in my head.”

It isn’t. The symptoms just aren’t reflecting a physical breakdown; it’s an emotional trigger that needs exploring.

3)      Mindful awareness of an emotion allows for its release.

Mindful awareness means placing attention on the experience without rejecting, criticising or analysing it. It means slowing down and approaching the experience with curiosity and kindness. Mindfulness allows the message and meaning of the emotion trapped in the body to be discovered.

Once deeply understood and connected to, the emotion loosens its grip and usually finds its own way out of the body.  The mindfulness process may not always be this simple and may need to be repeated a number of times, but the principle is the same. The only way to get over a feeling is to feel it.  We often just need someone to provide guidance and support on how best to do that.

*Name has been changed

This is an individual case study for educational purposes. Results obtained by one person does not mean the same  can be expected by another. Each person has different life experiences and circumstances which will influence responses.

Dr Nick BassalGeneral Medical Practice, Mindfulness-Based Psychotherapy – Wholistic Medical Centre