The COVID-19 pandemic and physical distancing have affected everyone. Spending almost every moment together as a couple can take a toll on relationships. The fact is that men and women have different types of communication styles and men are not as open to discussing their feelings. These differences can cause arguments and stress. Men also exhibit mental illness differently. To learn more, we spoke to Movember subject matter expert and Associate Professor of Psychiatry at the University of Toronto, Dr. Thomas Ungar.
Ungar started out as a family physician but decided to make the switch to psychiatry. He said, “Probably half of what you see in family medicine has a component of mental illness. A lot of the time, mental illness can manifest with physical symptoms like headaches, muscle aches, fatigue,” he continues, ”I hate the separation of medicine – I like the integration of care. If we could integrate the care, we could improve mental health across the board. It shouldn’t be this weird thing to get referred to a mental health specialist.”
Here is the rest of our discussion:
Men and women have very different ways of communicating. Self-isolating together can put a strain on long term relationships and lack of communication can impact short term relationships. What should both men and women consider when communicating with each other in these unusual times?
I’ve been married for 30 years and have three young adult children so I know all about this [laughs]. The sheer amount of time together can get challenging, even though you care about each other, it’s just human nature because you don’t have the break. Any two people together can get on each other’s nerves. These are generalizations, but men do not like to directly discuss feelings or any sense of weakness. They are socialized to not show vulnerability and be strong. It’s changing, but that’s very common.
Woman find it easier to socially connect with friends and to chat about things more directly. Those two style differences, depending on the individuals is often what is going on. Men can go quiet and get irritable when they are agitated. Women will want to chat and that pushes things into the opposite direction. Just acknowledging that, being kind, giving permission to each other and being forgiving is really important. You don’t have to be perfect and it’s not some daytime TV marital therapy or couple therapy perception thing. It’s just kind of surviving and being forgiving and accepting of the differences. It’s about lowering your expectations at a time like this and that’s a very healthy approach.
Most people are aware that women can suffer from post-partum depression due to hormone changes. You have talked about post-natal depression in men. What impact will social isolation have on post-natal depression in new fathers?
It’s going to exacerbate the likelihood of post-natal depression in fathers and precipitate a bit more of it. Having a child is a joyous, but also a challenging, stressful time. It’s a good stress, but it’s a huge stress. You experience everything from sleep deprivation to supporting your partner if you have one, to caring for the child. Right now, you are also withdrawing from society and that will exacerbate it even more. I think that the really big concern is the little breaks that you used to get whether it was the time that you ran out for coffee while the other person was with the child are reduced. Those little breathers or breaks are not there so that’s tough, even just to take a shower or have a nap if you are lucky enough to have someone else cover for you.
If both people have to worry about keeping the household afloat while caring for another dependent – and I think that everyone has worries about the impact of COVID-19 on the economy. Having money for food, for shelter and now care for another human at this time – I think that those are worries that any parent has. It is just all the more real with what’s going on and it’s not just COVID itself, but the impact of COVID on society and the economy.
You have discussed that men may require non-traditional methods of therapy. They may not do well sharing their feelings in group situations for example. You even use hockey as a reference point highlighting how to deal with COVID-19 anxiety. What does the future of psychiatry and mental health help look like for men?
I very much think of it a cultural design, contextual design – there is a whole field called designing services or system design or human design. I don’t think that the world of psychiatry and mental health delivery has paid that much attention to those kinds of design features that suit men in particular. It’s wonderful that they have identified women’s mental health and you’ve got a hospital in Toronto called Women’s College. Some of the programs, because of the prevalence of post-partum issues is designed around women’s mental health services. Very few or very rarely has there been any thought to designing something around the gender sub-group of men. You have the LGBTQ services but we’ve taken it for granted that men are fine and they are not. Three out of four suicides are men and they don’t come for help, they don’t reach out or talk as much. I don’t think that we have done a very good job of tending to them in particular.
Just the fact that men may not be into this psychiatric and psychological jargon. It’s just a different culture. I think, and I’m not over-psychiatrizing, just reaching out for help is going to be helpful. I don’t think that we have done a very good job of that. With men, you have to be really direct by asking them how they are doing and by looking, watching and picking up the indirect cues so that its not so threatening. The Movember Foundation does a great job of framing these things and they call it shoulder to shoulder as opposed to direct face to face to pick up the cues.
I don’t think we’ve done a particularly good job because men tend to withdraw more as opposed to reaching out and that’s a real challenge. I actually think that psychiatry reaching into to cultures, reaching into the context of where men are at, into the hockey dressing rooms, into the coffee shops, into the primary care offices or wherever they are will be the way to go. Movember is the most focused and they have done it in a really hip, fun way with the moustache campaign. It’s something that guys can connect with and have a lot of fun with. They are actually connecting really nicely and that is why I am so comfortable doing stuff with them.
There was little awareness of prostate cancer, for example. You hear about breast cancer all of the time. You weren’t hearing about men’s cancers and the man’s perspective. Movember really shined a light on men’s health in a way that hadn’t been done before.
That’s right. It’s interesting, and this is my other take, I’m agnostic about who you support. I think everyone needs it. If the main cancers for women are these, great, we need to look after that. But, if these are the cancers affecting men, and the causes of death are these, then we also need to tend to them and sometimes it gets lost. Men tend not to make a lot of noise because we don’t want to look vulnerable.
I work with the Mental Health Commission of Canada in their Structural Stigma Research Group. They have used terms like making the invisible visible or getting out of the shadows or shedding light. When you add mental health and coming out of the mental health closet, so to speak, and you add the male culture to it, it’s just that much harder for men to reach out when you speak about mental health conditions. Movember has this nice acronym, ALEC – Ask, Listen, Encourage Action and Check In. I think that picking up on the silent cues and checking in – and I do that naturally with friends and I’ve had some do that with me as well. Just to see how it’s going and that feels really nice without anything too touchy-feely.
Men use activity to help blow off steam, where women usually vent to their friends. In a time of social isolation, how can men and women compromise on these communication styles and cope with their struggles together? How can they help if they notice signs of mental illness?
Being compassionate, accepting and forgiving of each other’s differences always works. Giving the other person permission to do it their way is helpful. Guys do reach out to each other through phone calls and video chats too. I’m really encouraged with those and am doing them myself. They are using this term, social distancing, that isn’t technically correct. It should be physical distancing but social connectedness. You have to make some effort to socially connect in a different way for guys. Guys like to solve problems and take action, so even having something to do as a couple would be helpful.
The kind of worry and anxiety now is reality based. We are worried about getting food on the table and getting rent paid which are basic, primitive needs. It is natural and adaptive in the way that your anxiety is going. Anxiety can be a good signal to get you doing stuff. It’s not a mental illness in itself, but it can wear you down. Some people have a pre-existing condition or will tip into actual illness, have panic attacks or get down and suicidal. That’s a different problem where they have to connect and reach out and get some help. If you have a significant other, take note if something seems different.
Most people will have the fight or flight reaction The fight reaction is a good one for men, because guys like to take action. For example, I psyche myself up to come to work – it’s stressful and I’m going to have to wear a mask, but you remind yourself that you are in a battle here and that we are stronger than we think. I try to suck it up and do that despite my anxiety and ignore that I’m going to be nervous. I think that you should embrace the fight as long as it’s a healthy fight against the disease and not each other.
The flight is that you have to get out of the way of the virus which is the risk. Do your best to wear masks, wash your hands, stay home when you can. Don’t deny the fright because that’s going to play out at home in different ways when you are part of a couple. One or both people may be nervous, irritable or even down. You may also have physical symptoms like a headache, sweats or butterflies in your stomach. You have to attend to it, and acknowledge it. People’s emotional, cognitive and physical responses to anxiety will differ and that’s where they will get at each other. You will have different levels of tolerance to those responses. Just keep on eye out if something is out of character and address it right away.
What resources are available for men now that may be in need of help?
Start with your family doctor, Telehealth Canada, and the Crisis Services Canada hot line. You can find resources on Movember’s website and many are available are 24/7.
Without having a crystal ball, what mental health challenges are we going to see in a post-COVID-19 world and what can we do to take the pressure off of the mental health care system?
We are going to see a couple of things happen. We are seeing the first wave of the COVID infection and we are encouraging people to do virtual care. We are worried about the economic and social impact that comes from the isolation. These are things that can exacerbate or precipitate more mood and anxiety disorders. We are worried that there will be a wave of a different type of pandemic and this will be related to mental illness. This will get worse in a few months’ time. A few in a small subset may even suffer from Post Traumatic Stress Syndrome (PTSD) and that will include the health providers and frontline service providers.
I am seeing some good news stories come out because we’ve switched to virtual care and it’s working well! I could probably do 80% of what I do through virtual care. There has been a reduction in the bureaucratic barriers. There may be a huge shift in the way that service is delivered in the future and there may be even more access for distant communities. People will get better care overall. Mental health is funded less than physical health and we are working on that. There needs to be some equity in the resourcing for mental health which is one of the things that I am working on.