Breaking the Silence, not People: Men’s Mental Health and Organizational Wellbeing
As for being a poster child of law firm leaders with mental health challenges, [Simon] Malko admitted he did have a moment of doubt about coming out. “There was a little voice that asked, why are you doing it?” Quickly, though, he decided “it was the right thing to do.” — Simon Malko, Managing Director
This post mentions death by suicide. If you’re in crisis, help is available now in the US: Call or text the free, confidential 988 Lifeline at 988.
Well-being and organizational mental health experts often underline the following” “improving company culture and national discourse starts at the top.”
At the top of most power structures throughout society, however, there is usually a man who is a product of 1) a genetic lottery that may affect physical and mental health and b) a particular family and social context and set of lived experiences that will most likely shape how he manages relationships, deals with conflicts, responds to adversity, and gets what he wants.
The people and society around him imbued him with what it means to be a man and what might be expected of him around being a provider.
Chances are his winning formula for success—persistence, relentlessness, ambition, self-aggrandizement, and competitiveness that strains mental and physical limits—is a product of the factors described above.
Despite all the recent social changes, we are still being led by men who fit a certain view of what leaders and winners should look like. According to the Financial Times, in 2015, US investigators reported that individuals in the 75th percentile of height made 9% to 15% more than those in the 25%; in 2020, Chinese researchers reported that each extra cm of height produces a 1.3% increase in income. And when men don’t look fit or have obesity, research suggests that we assume they are less worthy of being recruited — even at the CEO level.
Chances also are that the flip side of this winning formula could actually be a mental health disorder, such as narcissism and sociopathy (over-represented in leaders) and bipolar disorder (over-represented in entrepreneurs), and an obsessive and neurotic need to succeed— sometimes the very pathologies that propel them forward. In their wakes emerge great organizations but also a lot of collateral damage, to others but also themselves.
Even though athletes like Michael Phelps and many others have talked about the cost of success and their mental health struggles, very few leaders have been willing to share the effect of the pressure they are under (for more on why leaders still pretend to be OKAY and why that is a problem for everyone, please join us here).
As global citizens, we should care about men’s mental health because 90% of countries are run by men whose struggles and pathologies might shape policies, cause wars, and inspire greatness. As management researchers, men’s mental health matters to us because men still account for 72% of C-suite leaders across many different sizes of companies in the US and lead nearly 90% of Fortune 500 companies.
Finally, men also run many consumer-facing technology companies that fill our minds and tug at our emotions in a digital version of remote control digital dependency. Some of the very design choices of social media platforms shape to whom we turn in elections and the pathologies to which we might gravitate.
Collectively, these choices and automatic behavior patterns shape societies and companies and inspire greatness, but also cause wars, perpetuate inequality, and exacerbate societal problems, making it even harder for the other 99.9% of men to feel needed, wanted, and secure.
The “Captains of our Souls” are not always captains of their own.
As Prime Minister of the United Kingdom, Winston Churchill was a resolute leader in fighting Nazi aggression, extolling the nation and its allies to “Never Give In.” “We are still masters of our fate,” he said in 1941 in a famous speech. “We are still captains of our souls.” However, Churchill was not always the captain of his soul as a man.
Only after Churchill died in 1965 did the depth of his mental health challenges become visible. Churchill called his depression and coarse moods his “black dog.” When this “black dog” visited, he experienced episodes of mood swings, periods of sadness, fatigue, insomnia, and even suicidal ideation. Churchill fought this darkness by immersing himself in work, writing as an emotional outlet, and leaning on the support of close confidants. Later in life, he took up painting.
Churchill’s management of his mental health could be a masterclass in staying level in difficult times. But it also illuminates a problem we are still struggling with today: men’s mental health and well-being do not get the focus they should.
In this post, we wanted to focus on men and their mental health struggles and the content that if we better understand what derails men from leading the healthy lives they might aspire to, we need to support men better—starting with boys, teenagers, and young adults.
Doing so will help families and communities. It will also, as is our deepest hope, help them build better organizations and nations and become the prosocial leaders that employees are clamoring for and that many of them may wish society would let them be.
We need to nurture men early on and guide them to learn that their emotions are not something that they should suppress. We have to teach them that their emotions are not something that should make them feel weak. Emotions are a tool of measurement, a guide. Their emotions signal what they value, have experienced, and their place in the world.
The state of masculine mental health in the US
One of the good outcomes of the pandemic conversations about mental health and greater access to digital resources is that the number of mental healthcare visits for men more than quintupled from 2019 to 2020. Still, in the US, fewer than half of men with signs of anxiety or depression seek treatment from a health professional.
Family and relationship challenges tend to be key drivers when they reach out for help. Distress in relationships is challenging for all parties but seems to put men at an increased risk of mental health problems. In addition, because the pressure to provide remains strong, workplace stress disproportionately impacts men.
To dull the pain, men turn to escape and resort to substances. Men are likelier than women to use substances, more likely to overdose, and have to go to the emergency room for substance use. The recent skyrocketing rate of online sports gambling addiction among men, especially young men, has been making the media rounds since its legalization in 26 U.S. states. And, unlike drinking and smiling, “gambling addiction has no tell.”
Stigma about addiction remains strong. As a result, men are more likely to find themselves without any hope or way out of the pain. Although more women attempt suicide and report suicidal ideations, the death by suicide rate for men is about four times higher than for women; the highest overall rate was among men over 65. Older men find it harder than older women to find confidants and become more socially isolated.
Why is it so hard for men to admit they need help and access it when needed?
As mentioned earlier, our mental health is shaped by a host of factors, including physiology, genetics, family relationships, life circumstances, and experiences with trauma. Culture and identity are also important.
The World Health Organization reports on how sociocultural constructions of masculinities affect men’s mental health and help-seeking behavior: self-reliance, difficulty in expressing emotions, and self-control. Economic insecurity, inequality, and limited health- and social-care provision — especially for marginalized groups of men — makes it even harder to remain mentally healthy and seek care when needed.
While we recognize that gender is not binary and that national and religious cultures vary, researchers talk about how people who identify as men can be challenged by norms around masculinity and expectations about how boys express themselves and talk about feelings and find it hard to seek support. They admitted to feeling more embarrassed than women about seeking professional help.
Cliches — “boys don´t cry” and “man up” — point to society´s push to limit the emotional expressiveness of men. When they feel emotional pain, they might then be more likely than women to suppress their feelings and get angry or aggressive. This, too, impacts how we, in turn, behave. It is hard to reach out to anyone who might be struggling, but reaching out to an individual who comes across as angry feels riskier — both emotionally and physically. A normal response to anger is avoidance and rarely expressions of love and support.
The notion that “boys will be boys” still absolves individuals from sanctions for misbehavior, and a lot of things men do (which are far worse) often get swept under the carpet. But also makes it easier for community members to chalk up what could be a mental health issue, presenting like anger, irritability, or reckless and risky behavior, for example, to “being a boy.” Making it harder to intervene early, which can often be key to better mental health outcomes.
In addition, the occupational gender split remains strong — and men tend to be in professions that increase the risk of sanction for coming forward. Men over-index in high-risk jobs, ranging from high-sea fishing, law enforcement, and firefighting to construction (with death by suicide rates nearly double that of men in other professions), mining, and entrepreneurship. Men are underrepresented in so-called caring jobs–such as educators, healthcare support, personal care and service providers, and retail and hospitality workers — reinforcing the notion that men might be less nurturing. And yet 40% of unpaid adult caregivers are men.
Finally, there are many theories for the causes of worsening health outcomes and higher substance use among men. We believe that a contributing factor is that it seems increasingly hard for men to find what they need — in a mate, in education, or the professional arena.
What we need is often driven by four main inferiority feelings: vulnerability (or insecurity), reduction (or powerlessness), enlargement (or perfectibility), adoption (or affiliation), etc. These might have triggering events that lead to concerns that cause us to make it the life goal to avoid these. When we cannot have our needs met, mental health worsens.
What can we do?
Understand men´s mental health over a lifetime.
Boys are more likely than girls to be diagnosed with disorders that can such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). These can cause significant behavioral, emotional, and adaptive challenges.
Outdated stereotypes and diagnostic tools about these disorders might lead boys and men to be overdiagnosed and girls and women to be underdiagnosed, much as outdated tools and assumptions about eating disorders and disordered eating might lead to an underdiagnosis in boys and young men through puberty and early adulthood.
As teens, they tend to take more risks and drugs. At this stage, schizophrenia can present; 90% of those diagnosed before 30 are men.
Middle age brings work and family stress. It presents with the prospect of aging and perhaps the proverbial midlife crisis, which is often cruelly presented in popular lore for the risk-taking that it can involve. “Dad bods” are also objects of online derision. Men who opt to stay at home still face social stigma and isolation.
These might also be times when men need to be supported through the IVF process, pregnancy losses, and potential postpartum depression, which, while more physically taxing on women, affect men deeply and often leave them feeling helpless and hopeless.
Finally, older men, like women, risk isolation and depression, but men tend to have few relationships.
Through it all, hormones affect men´s moods and ability to neuromodulate as they change and fluctuate — as they do in women. Absolute levels and daily fluctuations of testosterone — a key male hormone associated with risk-taking, sex drive, and aggression — play out differently in individuals. As those levels decrease, effects can include depression, loss of muscle and increase in body fat, lower libido, sadness, and also cognitive problems such as worsening memory and concentration.
While we are starting to talk about menopause, we still talk little about andropause, except, again, in the context of remaining manly and testosterone patches, rather than understanding feelings that might arise in men challenged by bodily changes and mood swings.
Watch out for patterns.
Mental health issues in men can present as increasing challenges with concentration and focus; changes in appetite, weight, or sleep, which may affect mood and energy levels as well as cause digestive and other physical issues; and feelings of hopelessness, sadness, or obsessing and ruminating. This might lead to more use and misuse of drugs and alcohol, gambling, or high-risk activities. Here, it is important to watch out for unhealthy habits or changes in drinking, smoking, and behavior patterns. These can be reflections of mental distress but also worsen mental health issues.
The earlier the intervention, the better—often, people, especially men, wait until they are in a crisis. Being vigilant about changes in presentation, affect, and behavior—micro signals—can help us lower the bar for improving mental health for men.
Reduce ethnic and racial disparity and break cultural norms.
In a world that still associates masculinity with power, success, self-reliance, and control, men who struggle with why they matter, who they are, and how they fit — along the lines of sexual orientation, ethnicity and race, disability, and social class — may experience more depression, anxiety, and other mental health concerns.
They are exacerbated by greater discrimination, insecurity, covering, racism, stigma, and disparities in mental health care.
Individuals who face ethnic or racial discrimination report that the added “otherness” of mental illnesses can stand in the way of getting help — and to talk about what is going on with loved ones.
Individuals might not want to share that they are having a problem with members of their family or community for fear of being discriminated against or treated differently. They are already treated as an ‘other’ as a minority, and don’t want to add to that. This can lead to a large disparity in access to and use of mental health resources.
A study showed that while 45.5% of white men 18 to 44 years of age sought help for daily feelings of anxiety or depression, only 26.4% of Black and Latino men did. In the Black community, most of the people seeking mental health treatment are women.
In 2024, the Harvard University Hutchins Center for African & African American Research called a symposium to discuss Black men’s mental health. They noted a 60% increase in suicide rates among 10 to 19-year-old Black boys between 2010 and 2019, declaring that this an issue of national importance. For these Black boys and men, trauma, high poverty rates, and implicit bias contributed to their poor state of mental health. Another initiative is the NIHMH’s Brother, Your Are on My Mind.
Consider a Black man striving to get a key promotion at work to provide for their family or climb the corporate ladder and make community-wide impacts. He faces the same challenges as other men but might feel the pressure of higher stakes. They already feel like imposters and already worry about stereotype threat and implicit bias.
By not allowing them to reveal and seek help for their mental health, we add yet another disparity in their calculation: “If I reveal any ‘weakness’ to my colleagues and friends, they will find another reason to devalue me. They will sort me into the category of ‘bad’ Black men.” By not embracing the unique challenges faced by Black men, are we contributing to the environment that deteriorates their mental health? Could the same be true of other communities? If so, we must find a manageable way to address the complexities and create a psychologically safe environment for them.
Reflection:
General: How does popular culture reinforce stereotypes about masculinity? What role does stigma play in making it harder for men to get the support they need or just to be heard and seen as emotional beings? What do we see reflected in entertainment and social media?
Personal: What cultural stereotypes might stand in the way of my fostering deeper connections? What assumptions am I making when talking to a man about challenges versus a woman? Am I focusing on the individual, not stereotypical boxes into which individuals might fit? Do I make it a practice to engage in cognitive reappraisal? To take a step back and view any situation objectively, suspending stereotypes and “a priori” assumptions and see the “whole person” or “whole situation” in its context.
Understand men’s struggles with body image and eating disorders.
The comparison of one’s appearance to the idealized and unrealistic standards portrayed in media and advertising further contributes to decreased self-esteem, anxiety, and depression. Despite mainstream beliefs, this issue doesn’t only affect women: exposure to idealized body images has also sparked high levels of depression, eating pathology, and overexercising among men.
Weight-based discrimination also affects men, especially the educated: obese men with a bachelor’s degree earn 5% less than their thinner colleagues, while those with a graduate degree earn 14% less. This weight penalty varies across sectors, with the greatest gaps (regardless of gender) in high-skilled jobs, e.g., obese workers in healthcare and management roles are respectively paid 11% and 9% less than thinner colleagues.
Subclinical disordered eating behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women. In addition, 22% of men engaged in muscularity-oriented disordered eating behavior, including eating certain foods and taking supplements and androgenic anabolic steroids to gain weight or “bulk up.”
Despite the advocacy around eating disorders, most people associate the pathologies with the SWAG acronym — skinny, white, adolescent girl. But about one in three of the nearly 60 million Americans who will be diagnosed with an eating disorder in their lifetimes is a male — across all economic classes but more in low socio-economic status households. The prevalence is much higher in gay or bisexual men: 15% of them report struggling with an eating disorder.
Tragically, men with eating disorders may have a higher mortality risk than women. From 1999 to 2009, hospitalization of males for eating disorders increased by 53% in the US. A Canadian study from 2002 to 2019 showed that hospitalization rates for girls increased by 123% for girls but 416% for boys. In 2002, boys accounted for 5% of pediatric eating disorder patients, but in 2019, they comprised 11.8% (especially 12- to 14-year-olds).
Reflection:
General: How do you ensure that your communication around mental health programs does not overprivileged women, including in the visuals?
Personal: How do fitness stereotypes impact how I feel about my health and my body? How often do I comment on people’s fitness levels and looks or my own? What am I trying to achieve with these comments?
Resource: For our post on eating disorders, the cost of seeking perfection, and how to build more supportive workplaces, please join us here.
Promote male friendships and relationships.
A major source of support for women struggling with mental health issues is their friends. These support networks are also key to helping individuals through inflection points that tend to aggravate mental health issues, such as being laid off or promoted, getting married or divorced, taking care of loved ones, and experiencing loss. Individuals who can identify that “web of stressors” and reach out to others at those times do better.
In these instances, women tend to cultivate more close friends than men and are more open to discussing emotions and fears. Recently, we heard the story of a man who came to his friend’s apartment after the latter had been laid off and was very distraught—“I will give you 50 cents on the dollar” was the friend’s equivalent of a pep talk. Humor is an elixir for sore hearts and minds, but it might have taken a special individual to follow up with how distraught he felt.
As noted earlier, men suffer more from social isolation, especially as they age. Sadly, while we are all losing our ability to form close friendships while we add virtual imaginary friends, it became even harder for men: men have just three close friends, half the number they had 30 years ago.
Online lives and social media's “compare and despair” nature isolate us further. In the humanity/technology co-dependence, interactions with a screen make it increasingly difficult to connect with flesh-and-blood people. This seems especially difficult for young men today.
At particular risk are single men, who report more suicidal ideation, and the number of single households is increasing. Being a man is also not easy in the mating arena. Match.com, ushering in the online dating market as we know it, came on the scene 30 years ago, and finding mates should have become a lot easier. Yet, for many men, especially heterosexual men, competing on these sites can be fraught and depressing. The “best candidates” get the most matches, and those left behind get frustrated — on Tinder, that is nearly guaranteed, as 75% of Tinder users are men. Here, too, it is an alpha male take-all world.
Reflection:
General: What are the hallmarks of solid friendships among men? What stands in the way of them becoming closer (stigma, partners, etc.)? How can men be better friends?
Personal: Who will you turn to when you need help? Who will catch you when you fall? Are you part of a peer group or community group? These do not have to be related to mental health but to passions or interests. How will you cultivate these bonds when things get busy and life gets in the way? How often do you pick up the phone to call and check in on someone, as we did during the pandemic — what a friend called the “you good?” call? When was the last time you told your male friend you loved him?
Mentor men.
In a world where fathers are intermittently present or absent altogether in the lives of young people, men do not just need role models; they need role players. In addition to supporting men’s mental health generally, we — especially men — can find young men and boys to mentor and nurture. Instead of presenting them with a blueprint of what manhood should be (because that’s what it has been), be the support as they face the unique challenges of today. Be their guide as they forge their values and identity.
Men who take on this challenge of mentoring another man will also experience a transformation in their mental health. In these types of connections, they also find purpose. Researchers have identified that caring for others and other acts of kindness can reduce feelings of depression and anxiety. This could help narrow the gap between men’s and women’s mental health, as women tend to be so socialized to be caregivers.
Rethink how men are made: every man was once a son.
If there are traits that we admire in fathers, we can reflect on how to nurture them in boys. How are we cultivating those traits in our sons? How does the social and economic climate affect this socialization? What critical challenges do burgeoning fathers face as they enter adulthood and have their first child?
Today, we have an entire ecosystem of television shows, podcasts, music, academic papers, and social movements advocating the importance of fatherhood and examining men's role in broader society. While all men are not fathers, all fathers were once sons. The average father is 30 years old when the first child arrives. The new dad, most likely born around the 1990s, would have influenced their conception of a father and their role in their children’s lives and society.
At the same time, the 1990s was an era like every other that presented an ecosystem of resources and societal pressures for the boy who would eventually become a father today would have to grow within. Today, we consider the same for a boy in 2024, who, in step with the trend, would be a father in 2054.
Reflection:
General: How have expectations around what is a “good boy” or a “great father” evolved? What view of men do institutions like schools or the criminal justice system seem to reflect in their design choices?
Personal: If my father was in my life or is today, did I try to understand what he might be going through? We usually come much later to realize that our fathers' imperfections are often generations in the making. If I am a father, how comfortable am I sharing my fears and struggles with children or at work? Do I worry that doing so will disappoint them or make them feel less safe, even though the objective is the exact opposite?
Reduce gender stereotypes — towards a Parents Day Holiday?
As a nation, we did not begin celebrating Father’s Day until 1972, only after the daughter of a widowed American Civil War veteran led the 63-year campaign to enshrine a celebration of Fatherhood into U.S. law and create parity with the Mother’s Day ritual established in 1914. Today we still send twice a many Mother’s day cards as Father’s day cards, and National Parents’ Day on July 28 in the US gets very little attention.
Perhaps it time for a rethink. The traditional father’s role and parenting roles have generally become much more fluid and varied in archetypes. Non-traditional family structures and non-binary parents suggest that our “days” are of touch with the times. To recognize the work of parents, regardless of gender and sexual orientation, the US could consider creating a “Parent’s Day” Federal Holiday — not on a Sunday. The holiday would not be about just us — possibly as parents — but the act of parenting.
Allow male leaders to show vulnerability and discuss mental health.
Our post starts with a rare business leader who has changed his firm by caring for his mental health and being open about it. Simon Malko told everyone that he had struggled. “When I became a managing partner [in 2019], I had a lot of anxiety. I was dealing with a lot at work and the stress of raising two kids at home,” he shared. “I had an awful lot on my plate, and I was struggling with managing it all. Most lawyers, if they’re honest, have these issues.” His firm had benefits but people were not using them, a big reason was stigma. He pushed to get an onsite therapist at the firm.
Another example is Maj. Gen. Ernie Liynski. He led on two fronts: first for three decades in the Army and second for his work to shed light on mental health issues among troops, trying to lift the veil of stigma that kills. He discusses how he came apart after returning from Afghanistan with PTSD. “There’s a shame if you show weakness,” he told The New York Times. “That’s the way I felt.” He sat in his basement staring into nothing for three years — avoiding parties, family meals, his preteen child, and the marital bed. He since widely shares how he healed with recruits and colleagues.
A leading male voice on mental health in the Black community is James Kinney, Chief People Officer at media and advertising industry disruptor S4 Capital and media.monks. He explains how his experience and personal journey as a person who had experienced mental health struggles has helped him deal with his professional stress and support others. “Workplaces tend to reward overworking and the strength of being tough,” Kinney said.” But now we know that being vulnerable and authentic and sharing your experience of mental health is actually what we consider now to be tough, right? So it’s okay to not be okay.”
When leaders admit to having struggled with and worked to address mental health issues, employees are likelier to do so and connect differently with leaders. “I’m hopeful,” Malko said. “I think there’s a strong business case for it. It helps with retention and signals that we care about people.”
Now, society needs to believe this for everyone.
Collectively, we can and must go from “Boys will be boys” to “Boys always were and forever will be humans.”
Men’s Mental Health Awareness Month began in early 1994 and gained traction throughout the 2000s. Despite this effort, we know that men are afraid to discuss their mental health.
While we know that we cannot fix a problem that we do not know exists, we have to ask ourselves: have we established the psychological safety to allow men to discuss their mental health? Have we laid the foundation for men to receive help without sacrificing their status, jobs, and relationships?
For all genders, ask yourself: do the men in your life trust you enough to confide in you if they need help? How do you know? Have they ever done it? We often see ourselves as refuges for men in theory, but when it manifests in front of us in the form of a spouse not doing their fair share around the house because of depression, an introverted brother alone in another state, an arrogant colleague failing at a project, or an avoidant friend that never reaches out for anything, we find ways blame the individual instead of the greater social context that they are in. Instead, we label them lazy, independent, stubborn, or aloof. Somehow, by looking at these men up close, we confuse their coping mechanisms with their character and intentions. At the same time, we write posts about how we need to support men to be vulnerable — but only in the month of June.
For men, ask yourself: do I truly support other men? Or do I see them merely as my competition? Would I allow a male colleague to be vulnerable with me without leveraging it to gain an advantage against him? While men seem to know their own individual pain, it seems the threat of competition among men for money, status, and mates outranks their compassion for one another. Any plea to liberate the community from the rate race is eschewed by accusations of reducing the rugged toughness of meritocracy with participation trophies. For these men, trying to lower the demands on men is equivalent to diminishing the progression of strong male values; it erodes families and even societies.
By not following through with providing young boys and men the space they need to be vulnerable, grow into themselves, and find a place to be useful and fulfilled in their community, we are wedging them in between the impossible demands of masculinity in modern times.
On the one hand, a boy can aspire to be a traditionally “strong” man, aesthetically revered but practically useless — as most high-powered and traditionally masculine work becomes obsolete. On the other hand, a boy can grow to be a newly progressive man that society claims to prefer but refuses to honor.
Those men in the messy middle of these dueling identities do not necessarily make peace with who they are. Instead, they experience an existential crisis.
We must ask ourselves: What help do we provide men in crisis? Do we have the same urgency as with women and children? In a world where brawn offers little added benefit to thriving, is our instinct to show compassion to everyone except men potentially vestigial?
Raising the next generation of boys must be a community activity. Toxic masculinity was not forged in one home. It was not decreed by one king. Over thousands of years, it was cultivated by leagues of powerful men (and perpetuated by some women) within a specific socio-economic context. If we want to change the trajectory of men and masculinity, we must consciously mold an adaptive model of manhood so that it can thrive — not survive — in our rapidly changing social climate.
We must challenge our preferences, question our behavior, and encourage experimentation. We have to tamper and replace our impulse for shame and ridicule with an impulse for compassion and redirection. If we want men of the next generation to be different, we have to begin to treat men differently.
From Cancel To Kintsugi
The Japanese government describes a century-old ceramic repair process, Kingsugi, as the heating power of pottery repair. Instead of discarding the broken pieces or repairing them in a way that obscures the breaks, Kingsugi practitioners use lacquer (urushi) painted and decorated with gold or silver powder to turn the breaks into totally distinctive, unique elements. The break becomes a source of reconfiguration.
Similarly, addressing men’s mental health issues in a way that does not discard those who suffer nor make their challenges invisible can turn vulnerabilities into strengths, creating more resilient and compassionate individuals and leaders of countries and organizations.
Thank you for reading our post. Mel Martin and I would love your feedback and suggestions on supporting men’s health.
