Last year, I read Of Boys and Men by Richard Reeves. In his research, Reeves outlines various factors leading to boys and men feeling excluded from society and failed by various systems, whether it be education or the workforce. One section states how men struggle after divorce or relationships ending, especially if they do not find a new partner. None of this information is new, but it has made me look at the increasing referrals from men that are sent to my clinic each week.
Many men are socialised to prioritise strength, independence and stoicism, making it difficult for them to open up and form emotional connections. Many ageing men experience loneliness due to the loss of a partner and friendships. The following is an example of the kind of cases I see frequently in my clinic.
Colin* is a 49-year-old sales manager with bipolar disorder who presents after a five-week admission to the mental health unit for mania secondary to medication noncompliance, alcohol abuse and a recent separation from his wife. During his most recent manic episode, he had an affair with a co-worker and subsequently was suspended by his employer. Colin was facing significant work stress with deadlines. He reduced his medication without discussing it with his doctor. He thought he would work more effectively as he found his mood stabilisers and antipsychotic medication sedating. Unfortunately, this lead to poor sleep, increased hypersexuality, alcohol abuse, grandiose ideas to improve sales at work and increasing arguments with his family. Colin’s wife and children contacted mental health services, which resulted in an involuntary mental health admission where his medications were reinstated.
When I meet Colin, he is living alone in a short-term rental. After learning about the affair, his wife asked for a separation and he was forced to leave the family home. Colin had a previous affair and this is the fifth manic episode in the course of their 30 years of marriage. His two adult children have sided with their mother and Colin is feeling unsupported. “It’s like I’ve been left in the cold,” he says. “I need their support now though.”
His employer has been more forgiving because he is one of its top performing employees; however, the company wants him to see a psychiatrist and create a return-to-work plan.
Colin is motivated by his children who keep in contact, albeit from a distance. He agrees to attend regular AA meetings and group therapy. He knows he needs to take his medications regularly, but he lives alone and there is no one to help enforce it. I advise him to take a month off work, return part-time and gradually increase his workload over a few months.
I recommend reaching out to close friends. Colin forces a laugh and tells me he doesn’t have close friends. The friends he had were through his wife and they have been distant since the affair. I enquire about colleagues and he says that despite many years at the company, he only has superficial friendships. Colin’s eldest son, Adam*, comes to one of the reviews and provides more information about his father. He paints a picture of a man who, while loved, causes excessive strain on the family when not taking his medications. When I ask about Colin’s wife, Adam is not optimistic about their chances of getting back together. “She’s had enough of him.”
Despite all this, Colin seems generally upbeat but comes across as a lonely person. He takes his medication, attends group therapy and his return to work is initially awkward but successful. We agree that he attends part-time work for a few months to minimise stress. Colin still lives alone but is talking to his wife and is hopeful for a reconciliation. We schedule a review in two months. Colin misses this appointment and sends an email apologising but not providing context or rescheduling. Two weeks later, I get a phone call from a police officer stating that Colin has killed himself.
Adam comes to the clinic and thanks me for the support. He is grieving his father but also looking for answers. He confesses he feels that he failed Colin. Adam says he has come to pay the fee for his father’s missed appointment. I tell him that won’t be necessary. I make the assumption that the real reason was that he wanted to talk to someone about his father, someone who had known him before the end. Adam has been tasked with organising the funeral because his younger sister and mother are too overwhelmed with grief. Finding friends of his father to attend the funeral has proven difficult. Adam makes a hurried goodbye and apologises for taking up my time. I see similarities in father and son – two men trying to keep it together.
Mental health services are trying to engage lonely men with various strategies. We know that most men do not phone helplines when they are in crisis, many struggle with individual therapy and men’s-only group therapy is not readily available. Governments are having discussions on policies to have interventions aimed at boys in schools. Holistic practices such as exercise (gym, running or sports), a healthy diet and good sleep hygiene also help, but it is not enough. I’m optimistic that we will get there, but it sometimes feels like nothing is changing while men are struggling.
Most psychiatrists have a case similar to Colin’s. The ages and mental illness may vary, but loneliness is too often a factor.
• In Australia, the crisis support service Lifeline is 13 11 14. In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counselor. Other international helplines can be found at befrienders.org
*Patient examples are amalgamations of people often seen by psychiatrists
• Dr Xavier Mulenga is an addiction psychiatrist based in Sydney
