For depressed and suicidal men, the holiday season can add unwelcome pressures

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      The next time you're at a seasonal office party, holiday event, or family gathering, you might observe something like this: a guy standing off to one side by himself, keeping away from the rest of the lively crowd as everyone else parties on.

      You might write it off as social awkwardness, boredom, or exhaustion, which the case may very well be. On the other hand, there may be something else going on under the surface that may be unexpected.

      It's something UBC Men's Health Research founder John Oliffe discovered in a recent study about suicide and men, published in the American Journal of Men's Health on November 24 ("Injury, Interiority, and Isolation in Men's Suicidality").

      On the line with the Georgia Straight, Oliffe explained that there are many misinterpretations about the behaviour of men in relation to depression and suicide, a subject he has been conducting research on and organizing various projects about in Vancouver.

      UBC School of Nursing professor John Oliffe

      The myth of the loner versus the social butterfly

      He pointed out that troubled guys will often isolate themselves as a self-defensive measure.

      "In depression, a lot of guys will self-isolate to protect themselves and even to protect others," he said. "Christmas is one of those ones where if you don't want to bring the party down, you might not go to the party."

      While the holiday season may be a prime time for socializing, depressed or suicidal men may feel alienated by their lack of connection with what's going on around them.

      "Christmas cheer and holiday cheer and all that sort of stuff can be especially isolating," he said. "There's a bit of pressure that the mood's meant to be up and that it's meant to be cohesive and join together and feeling good and marking the end of the year, but in many cases for these guys it's probably not exactly what they're feeling, by any stretch."

      Unfortunately, Oliffe found in his study that such isolation heightened the risk for suicide.

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      He added that the holidays have numerous demands, such as generous gift-giving irrespective of a person's financial state or the need to travel or visit others. There's also potential for latent familial or relationship tensions and drama to arise. For some, the holidays can serve as a painful reminder of lost loved ones or may highlight the lack of close connections in one's life.

      Adding to all that are Vancouver's unbroken stretches of rain and darkness during the winter months, which can be hard on those who are new and still adapting to the city.

      "It can confine people to home," Oliffe said about the impact of the local weather. "So it's not just the climate, it's that for a lot of folks, it just stops them from doing active things, so I think that can add to it, for sure."

      What's more, Oliffe said his study revealed that due to the secretive behaviour of many depressed men, social isolation may not be just about the "lonely guy in the corner". It can sometimes be the gregarious guy in the middle of a crowd.

      "Some of those [depressed] guys are actually well-connected," he said. "They've got people around them. It's just that they're not connecting. It's because they're kind of caught up in their feelings and they're driven inward and so even though they've got people around them and it might look like they're functioning to some extent, they actually can be really quite at risk for suicide."

      Oliffe said that many men may feel the need to "pass" as everyone else or put up a front to pretend to be like all the other guys.

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      The social aspect of the holiday season also offers numerous opportunities for alcohol or drug usage—which can be a potential hazard for depressed or suicidal men, and overuse can exacerbate or even inflict new emotional wounds.

      "Oftentimes men will associate rest and relaxation with alcohol use or drug use," Oliffe said. He pointed out that men who overindulge may face heightened stress, hangovers, or going back to work or school depleted rather than fully rested, all of which can compound mental-health issues.

      The unusual thing, he opined, is that we accept it, often don't question it as a symptom of depression, or even write it off as a rite of passage.

      Drinking or drug use, or even obsessively throwing one's self into activities such as fitness or work, may also be something men resort to as a means to deal with their internal problems.

      "They'll try to outdrink it or try to outrun it and oftentimes you'll see a guy doing heaps of exercise at one level, just trying to outrun some of the feelings and some of what's going on for them," he said, "and then you'll more often see guys who are giving some kind of self-medication in the booze or in drugs, and it can help, in the short term, but we know that it really is, at best, a band-aid and oftentimes takes them deeper into depression."

      When man talk is tough

      All of these measures are, in fact, avoidance of delving down to the root issues.

      Oliffe said the majority of guys are reluctant to acknowledge depression because it can be perceived as a weakness. He explained that because many men feel pressured to be rational, decisive, independent, and self-reliant, asking for help may be misinterpreted as two things that run contrary to masculine ideals: that they have a problem, and that they can't fix it themselves.

      As Oliffe's study points out, emotional wounds, trauma, loss, or neglect experienced during childhood or formative years may be interpreted as weaknesses that contrast masculine values of being strong, stoic, and resilient.

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      Participants in the study expressed a losing battle to overcome their emotional injuries, and their failure to do so further added to their self-perception of failing to achieve masculine ideals of self-control and autonomy.

      While it has always been taboo to talk about suicidal issues, such codes of masculinity can prevent men from verbalizing their deeper feelings.

      "There are a lot of things that guys maybe don't talk about, and one of them would be a vulnerability around 'self', so if you are feeling things around self-harm, there might be a great deal of shame in trying to articulate that," Oliffe said. "Guys tend to internalize. So much of what they ruminate on are things that they don't always express in terms that we can understand what's going on for them."

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      What Oliffe found from previous projects about prostate cancer, smoking cessation, and injury is that many men found it easier to talk about photographs they had taken to illustrate what was going on for them. Photographs helped the men to open up by starting the discussion in an indirect and unstructured way.

      In his study, which included 20 straight, gay, and bisexual men (aged 20 to 62 years old) with a history of suicidality and from various ethnic backgrounds, participants were offered a camera to help them take pictures that illustrated their experiences and perspectives.

      Oliffe explained that the use of a visual element not only helped them to express something through nonverbal means but it gave them some emotional distance from intimate and sensitive issues. Many men were able to talk about themselves in the third person ("he") rather than first person ("I").

      When they were able to talk about suicidal thoughts, he said they found that the men were scared and "worried by the thoughts of self-harm".

      Reaching out

      Oliffe emphasized the value of friends and family in providing a supportive space for men to discuss what's going on for them.

      "Sometimes the permission of other people will open up a conversation that they might not have solicited themselves," he said.

      While some people may feel intimidated or uncertain of how to start such conversations, Oliffe recommended using open-ended questions, rather than direct, blunt, or confrontational ones with yes-or-no answers.

      "I often start the conversation with my mates by saying: 'A lot of blokes feel stressed about A, B, C, and D. How is it for you? How do you deal with that?' and I'm trying to sort of talk to them about what level of coping they might have or what level of strategy they might have," he said.

      In other words, rather than searching for a specific answer and pushing a guy into subject areas he may not want to talk about, offering a conversational space for a guy to have the option to express whatever he chooses allows him to lead the way with what he feels most comfortable with.

      If the discussion does delve into deeper issues, Oliffe suggested that people can weave in recommendations for formal help or resources if necessary. One such recommendation that Oliffe suggests is Headsupguys.ca, a website created by UBC to address men and depression. It includes a self-assessment test and information about depressive symptoms.

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      While men are committing suicide at a rate three to four times that of women, Oliffe's study points out that gender-specific suicide prevention is a subject that has been long neglected by research. That oversight may in itself reflect how deeply engrained codes of masculinity run in society—to the point that such issues may have gone unrecognized or invisible for far too long.

      He added that although a government bill passed in 2012 requires a suicide-intervention policy to be created in Canada, that has not yet happened.

      Unfortunately, Oliffe's funding from the Movember Foundation for research in this area has also come to an end. While they're searching for new sources of funding, he said that anyone interested in donating to help them continue their research can do so at their website Man Up Against Suicide.

      "This is a significant men's health problem that some intervention and policy would really help to address because this seems so preventable to me," he said.

      If you or someone you know is experiencing depressive or suicidal thoughts, some options for resources include talking to a healthcare professional, such as a doctor, psychologist, or counsellor. If in crisis, contact 911 or go to a hospital immediately. 

      The Crisis Intervention and Suicide Prevention Centre of B.C. offers 24-hour phone and online distress services (as well as community education). The Crisis Line Association of B.C. (1-800-784-2433) provides 24-hour service for individuals across the province.

      For LGBT people, options also include contacting Health Initiative for Men or Qmunity for queer-specific resources, particularly for issues related to sexual or gender identity.

      Kids Help Phone (1-800-668-6868) is a national service for children and teenagers. 

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