Adam had never been to therapy — and he wasn’t sure he needed, let alone wanted, to be here. He was meeting with me at the insistence of his wife, who, according to Adam, “thinks I have anger issues.”
Adam cares deeply for Sara, his wife of 10 years, and their three young kids. (The family’s names have been changed to protect their privacy.) He recognized that his angry outbursts scared them.
The outbursts scared him too. “I don’t know what comes over me,” he told me. “I feel like Jekyll and Hyde: One minute everything’s fine, and the next I’m seeing red.”
Adam agreed that the outbursts needed to stop. As to whether they were, as I suggested, a sign of deeper issues, he remained doubtful.
The Silent Epidemic
After a decade of treating men in psychotherapy, I’ve met hundreds of men like Adam — men who come to therapy convinced that other than the occasional blowup, they’re doing just fine.
I’m also keenly aware that there are plenty more men like Adam who never seek therapy at all.
Though men have significantly higher rates of substance use disorder and are four times more likely than women to die by suicide, they are far less likely to seek mental health treatment.
And those who do go through therapy may not find it effective.
Studies suggest that healthcare providers tend to miss or misdiagnose mental health symptoms in men and underestimate the severity of their concerns. This happens, in part, because men tend to mislabel the symptoms of conditions like depression as “stress.”
Men, as well as their providers, may also focus more on external behaviors — drinking, aggression, serial cheating — than on their underlying source.
This isn’t a coincidence.
[Real] believes many men are unknowingly suffering from what he terms “covert depression”: a chronic and elusive form of melancholy “largely hidden from his own conscious awareness.”
Family therapist Terrence Real, LICSW, author of numerous books on relationships and men’s mental health, argues that depression and other inner struggles tend to be viewed as weak or unmanly, so men often deny that they’re suffering — to those around them and to themselves.
“Traditionally, we have not liked men to be very emotional or very vulnerable,” Real writes in I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression. “An overtly depressed man is both — someone who not only has feelings but who has allowed those feelings to swamp his competence. . . . This attitude often compounds a depressed man’s condition, so that he gets depressed about being depressed, ashamed about feeling ashamed.”
Real contends that statistically lower rates of depression among men are misleading. He believes many men are unknowingly suffering from what he terms “covert depression”: a chronic and elusive form of melancholy “largely hidden from his own conscious awareness.”
Sucking It Up
Mental health was not a dinner-table topic in Adam’s childhood home. His mom was kind but passive; his dad, a taciturn Vietnam veteran, worked two jobs and spent weekends tinkering with old cars. Whatever connection Adam and his father shared was centered on doing — fishing, hunting, watching football — rather than talking.
That dynamic seemed fine until Adam was 10 and his parents divorced.
Adam recalled sitting beside his mom as she cried, biting back his own tears because, he said, “I needed to be strong for her.”
Adam was echoing what he and countless other boys have learned: A “good boy” is stoic, calm, and emotionless — no matter what.
Studies show that most American men were taught as children to act strong, even if they felt scared or nervous. And though this message may be evolving with the times, it’s hardly extinct: One 2018 study reported that one in three boys between the ages of 10 and 17 believed society expects them to suppress their emotions and to “suck it up” when they feel sad or scared.
This narrative runs especially deep in certain communities.
Therapist Jor-El Caraballo, LMHC, author of several books on Black men and mental health, including Self-Care for Black Men: 100 Ways to Heal and Liberate, considers emotional suppression one of the devastating legacies of slavery.
Caraballo describes “the burden of being a brute” — an expectation that Black men are endlessly strong and resilient — as “incredibly taxing.”
“It denies humanity,” he says. “It denies those sad moments, those depressive moments, those anxious moments, those moments where we don’t feel tough.”
“Sucking it up” comes with physical costs, too. Chronically suppressing emotions can tax the immune system, increasing the risk of heart disease, high blood pressure, and other health conditions.
(Learn more about the unique mental health issues facing Black men — and strategies for healing and breaking cycles of generational trauma and inherited patterns — at “Self-Care for Black Men.”)
Emotional Blockage
When I suggested that Adam’s mom or some other adult could have comforted him and not the other way around, Adam waved the idea away.
“The divorce was hard, but they made sure I always had enough to eat and got up for school on time,” he explains, as though food and an alarm clock were all that a 10-year-old boy enduring his parents’ divorce might need.
“My sister was the emotional one,” he’d said another time. “Me, I’m kind of clueless when it comes to feelings — like any other guy.”
I often hear men echo this sentiment, convinced they are biologically less emotional than women. In fact, studies suggest men’s physiological responses to emotion-inducing experiences tend to be more pronounced — they just often hold it in rather than express what they’re feeling.
Studies suggest men’s physiological responses to emotion-inducing experiences tend to be more pronounced — they just often hold it in rather than express what they’re feeling.
This reflex can become more fully — and dangerously — entrenched among men whose jobs demand emotional compartmentalization.
Martin Bradley (a pseudonym to protect his privacy), a detective in Minnesota, has been working in law enforcement for more than 20 years. “If you do this job long enough, you’re going to see terrible things,” he says. “You have to learn how to tamp down your emotions.”
Neither male nor female officers are immune to the stress, but the men seem especially ill-equipped to cope with it.
Statistics bear this out — the vast majority of officers who die by suicide are male — and Bradley has observed this on the job. He’s noticed that female officers seem more at ease acknowledging the toll their work takes.
“When we debrief after a significant incident, the women in the room are usually much more comfortable expressing their emotions,” he says. “I think that discomfort in expressing emotions is why the cumulative stress seems to hit men harder.”
Suffering in Silence
Within a year of his parents’ divorce, Adam began getting in trouble at school. He’d argue with other kids and come late to class; within a few years he was skipping school regularly. By the time he reached adulthood, Adam was known both as a heavy drinker and, as he put it, “a good guy who turns mean if I stay at the bar too long.”
He has worked hard to get sober, but the acting out persisted. The hurt and fear he couldn’t name came out sideways: Irritability, impatience, and sometimes even rage spilled over despite his best efforts to swallow them.
“I hate when I yell — it’s not who I am,” Adam explains. “My friends would be shocked if they knew how I acted. I hate that it only comes out with Sara and the kids.”
If Adam had ever opened up to his friends, he might have learned that many of them struggle with the same issues. Men experience anger more frequently than women, according to survey data collected by Ryan Martin, PhD, the author of Why We Get Mad and How to Deal With Angry People. Martin’s findings also suggest that men’s anger is more likely to lead to arguments, physical altercations, and damaged relationships.
But Adam told me he couldn’t dream of sharing something so personal with his friends. As with his relationship with his dad, Adam’s male friendships centered on doing, not talking. The only person he had ever shared his deeper feelings with was Sara.
“Men, at their core, are just as dependent, just as emotional, just as wired for connection, as women are.”
This dynamic prevails in many heterosexual relationships. While both men and women tend to rely primarily on their partner or spouse for support, men are significantly less likely to also lean on friends or family members, according to a 2025 Pew Research Center report.
When I encourage my clients to share something personal with a male friend, they typically say something like “That’s not how men talk to each other.” To which I respond, “Because they can’t, or because they won’t?”
Not only are men who refuse to share their distress lonelier and more prone to depression, but they’re also falling victim to yet another humanity-denying stereotype. “Men, at their core, are just as dependent, just as emotional, just as wired for connection, as women are,” Real writes in How Can I Get Through to You? Closing the Intimacy Gap Between Men and Women.
Moreover, romantic relationships can become strained when one partner is the other’s only source of emotional support. What happens when a partner doesn’t have the bandwidth to listen and empathize? Or when the relationship itself is the source of stress?
This reluctance to appear vulnerable also leads men to think they’re alone in their struggles. The ensuing shame — everyone else has it together but me — only fuels further silence and isolation, a vicious cycle that has captured many of my male clients.
Healing Out Loud
How do you fix a problem no one wants to talk about? Well, you start by talking about it.
“Acknowledging it is the first step for most anything in healing,” says Caraballo. “You have to acknowledge there’s an injury. Then you can treat it.”
When it comes to men’s mental health, that means challenging cultural narratives that denote who is “allowed” to struggle, and then to describe what that struggle might look like.
It means considering whether the boy who punches a hole in the wall might be sad rather than bad, or whether the boy who barely reacts to stress might actually be terrified to show what he’s feeling. It means teaching boys that crying is a healthy release of emotions and not something shameful.
The culture of suffering in silence must shift as well. Men need to know that it’s safe to feel the whole range of emotions, and that they can share those emotions with others.
The culture of suffering in silence must shift as well. Men need to know that it’s safe to feel the whole range of emotions, and that they can share those emotions with others.
To normalize discussing mental health, Bradley makes a point to check in with fellow officers who’ve been under stress or were exposed to something traumatic. Though he appreciates systemic efforts to destigmatize mental health issues among law enforcement, Bradley emphasizes that “real conversations matter more than posters on the wall.”
“It starts with something as simple as asking, ‘Hey, are you OK?’”
And while they can’t undo the past, men can make space for the feelings they were forced to suppress. This can reveal new possibilities.
As Adam reflected on his parents’ divorce, he realized that he hadn’t actually been OK back then. The fighting, drinking, and skipping school represented pain made manifest.
This realization hit especially hard when he recalled that his own son was nearly the same age as Adam had been when his family fell apart. “I see my son, how young he is — still a kid,” Adam says. “He’d be crushed if Sara and I split up. I would never want him to think no one cared how he felt, or that he couldn’t ask for help.”
Adam decided that he wanted to model something different for his son. As we continued our work together, he practiced noticing and naming his emotions, and he learned to see them as harbingers of real and valid needs like rest, connection, or honest conversation.
Pushing himself past fears that she would judge or reject him, he confessed to Sara how scared he was that she’d leave him or see him as less than a man when his paycheck didn’t seem to stretch far enough. He was surprised by how positively his wife responded. She was relieved to finally know what was going on inside him.
Though Adam remained reluctant to let his friends know what had been going on at home, he did make the decision — equal parts terrifying and liberating — to tell his dad that he’d been going to therapy. “He was kind of quiet at first,” Adam recalls. “Then he said, ‘Good for you.’”
Resources for Healing
A good therapist can help you recognize emotions, change unhealthy patterns, and better understand yourself. While it’s not essential to choose a therapist who specializes in working with men, you may find that those who do are more attuned to the issues they experience.
The website Man Therapy features a provider directory searchable by state, and the Find a Therapist tool on the Psychology Today website includes a “Men’s Issues” filter.
Group therapy can also be a great resource, offering the kind of vulnerability and connection male friendships often lack. Search for local groups on Psychology Today, or check out the ManKind Project, Black Men Heal, or HeadsUpGuys.
This Post Has 0 Comments