Dr Ali Haggett is a Senior Research Fellow at the Centre for Medical History, University of Exeter. She works primarily on the history of gender and mental illness and has just published a Wellcome Trust-funded Open Access monograph on male mental illness entitled A History of Male Psychological Disorders in Britain, 1945-1980. This post was origionally published on the History and Policy website.
Although women are likely to be diagnosed twice as often as men for the most common psychological disorders, the most recent suicide statistics for the UK, issued by the Office for National Statistics, show that the male suicide rate is now more than three times higher than the female rate.
Overall, the most recent data on record shows that 4,858 men ended their own lives in 2013, and men aged between 45 and 59 are currently most at risk. Over recent months, expedited by pressure from a number of charities concerned about male suicide, these sobering statistics have begun to attract wider publicity in the press and on television documentaries. BBC 3, for example, recently featured a programme in which rap artist Professor Green explored the harrowing circumstances surrounding his Father’s suicide.
The gender gap in suicide statistics, while shocking, is not new. Data from the beginning of the twentieth century indicates that, notwithstanding a moderate rise in female suicide during the 1960s, the male rate of suicide has always been significantly higher than the rate for women. The scandal is why it has taken so long for the topic to attract the attention it deserves. Studies into suicide during the 1950s and 1960s focused on comparative data between different regions of the UK and examined the influence of other variables such as class and age. While these factors were not unimportant, the fact that men featured in statistics so predominantly has always been ‘the elephant in the room’.
There are complex medical, social and cultural reasons why men might be more likely to end their own lives. These too have a long history – but one that could help us disentangle some of the current problems. The subject of seeking help for psychological disorders certainly seems to be one area that presents particular challenges to the current Western model of masculinity. In part bestowed upon us during the Victorian era (a period in which British ascendency in the world required the projection of ‘power’ and ‘control’) the notion that ‘real’ men should be stoic and independent resulted in boys and men being encouraged to minimise the expression of pain and emotion.
By contrast, during the preceding period, the Georgians viewed nervous disorders as a sign of ‘good breeding’. Advances in scientific and anatomical knowledge from the practice of dissection suggested that the central nervous system was fundamental to understandings of the body. A new interest in nervous disorders, which were thought to affect men and women alike, lead to a belief that the individuals thought to be most seriously affected by ‘nervous distempers’ were those from the cultured, well-to-do classes, who were considered to have a more refined nervous system, which was more prone to collapse. As a result, men were more comfortable being reflective about their own physical and psychological experiences.
It might be helpful to remind ourselves that masculinity has been ‘fluid’ through time – we could look to earlier periods and alternative constructions of masculinity to foster healthier ways of expressing emotional distress.
During more recent times, a number of additional factors might help explain why much male distress remained undetected. From the 1950s, the biomedical model of health and disease predominantly practised in the West, has tended to underplay the role of social and cultural factors in mental health, making it unlikely that the role of masculinity has been considered satisfactorily. When men do seek medical help, they often present with physical or psychosomatic symptoms that may have an underlying emotional cause. It is therefore likely that male cases of depression and anxiety have been under-diagnosed.
In the workplace, debates about sickness absence have historically been dominated by concerns about productivity, resulting in a failure to investigate male psychological illness at work. This has been the case since at least the 1950s when debates about occupational health became fixed upon a number of key threats to health: unemployment, absenteeism, physical and chemical hazards.
By the 1980s, commentators began to caution that mental health had been of subsidiary interest. Dame Carol Black’s report, on the health of the working population, published in 2008, revealed that the importance of the physical and mental health was still ‘insufficiently recognised by society’. As the charity Men’s Health Forum pointed out, this had potentially serious consequences for men who spend more of their lives in the workplace and are less likely than women to make use of statutory health services.
Finally, it is likely that the stigma of mental illness has affected men more acutely than women. The long-held association between women, psychological disorder and ‘weakness’ has been particularly problematic for men who are often reluctant to admit to vulnerability and not ‘coping’. Recent research continues to enforce the association between depression and women. However studies on gender and depression too often draw upon data from surveys that rely on self-reporting. Since men are less likely to recognise or report symptoms of emotional distress, it is not surprising that women feature more regularly in the data.
The constituent countries of the UK have each produced suicide prevention strategies to identify risk and take action across-sector organisations. Young and middle-aged men are now considered to be high-risk groups. There is also now a growing body of excellent academic work on male mental health and the on the commissioning, design and delivery of interventions.
However, there is an important role for history in these developments. By exploring the social and the cultural, as well as the medical and the psychological, and by viewing ideas about male behaviour within the context of their time, history illustrates how symptoms have been viewed differently in response to prevailing cultural and medical forces. It offers us the opportunity to expose and uncover male ‘distress’ where it seemed previously hidden, but was perhaps prevalent, either presenting in complex ways or undiagnosed in the community.
The longer view most certainly suggests that for too long we have been constrained by a biological paradigm and the unhelpful notion that one sex might be biologically more vulnerable to mental illness than the other. A more productive approach would be to explore what it is about being a man or a woman in our culture that make us react differently to psychological stress. For future generations, interventions that promote healthier ways of expressing emotion in young boys will be key.
* Author’s note: It should be acknowledged that not all suicide is caused by mental illness. However, it is known that people with mental health problems are at greater risk of suicide.