Author: John Budin
As a psychiatrist living with bipolar disorder, I have been both a care receiver and a care giver. Over the span of my career, I have treated many men with bipolar disorder having the luxury of viewing them through the lens of being both a clinician and a patient. Though men and women have the same lifetime prevalence of bipolar disorder, it has been my experience that the expression and co-morbidities differ notably between the genders.
To begin with, allow me to review some basic facts. It appears that men have an earlier age of onset of bipolar disorder than do women. Men are likely to exhibit their first symptoms at age 22, on average, with women typically having an onset three years later. The literature, affirmed by my own experience, suggests that men are more likely to have their initial mood swing be mania while in women it is more likely to be depression. Some studies suggest that men have a greater number of manic episodes over the course of their illness than do women, and these manias are associated with more intense levels of aggression in men. As well, depressive episodes in men are more frequently associated with irritability than is the case with women. Of note, men with bipolar disorder are much more likely to have co-occurring substance use disorder than women. Some have suggested (I agree) that it can be more difficult to diagnose early onset mania in men because some of the typical manic symptoms (aggression, over-confidence and boldness, for example) are traits that we often associate with masculinity.
Our cultural gender stereotypes play a large role in how men react to having a psychiatric illness. There is great stigma attached to having a mental health condition, especially for men, in my opinion. Males in our society are encouraged to be invulnerable, self-sufficient, in control and emotionally level-headed. Expressions of affect are frowned upon and judged as being “weak”. We expect our men to be stoic and “strong” and harshly judge those who fall short of this unrealistic and unhealthy expectation. It is no surprise then that men are more likely to deny their illness than are women. I shunned treatment for far too long even though I was a psychiatrist and knew my diagnosis. Those with untreated bipolar disorder suffer needlessly and the higher rate of suicide amongst men is heartbreaking.
Though these statistics are sobering, there is much to feel hopeful about. It is clear that men respond just as well to treatment (medication, therapy and group support) as do women. Exercise, healthy eating habits and good sleep habits are the three pillars of self-care that many with bipolar disorder regularly incorporate into their daily lives. Millions of men across the globe have stepped forward and are receiving the care that they need. We hear with regularity from those in the national spotlight (celebrities and sports figures, for example) who come out of the mental health “closet” and publicly acknowledge that they have bipolar disorder.
My own experience is reason for others to be hopeful. I shunned psychiatric treatment for far too long for fear of being judged and because of the stigma against mental illness in the medical community. When I have shared my diagnosis at conferences and with colleagues, family and friends, I have been stunned at the response, receiving more affirmation and hugs than I could have ever imagined possible. My own harsh self-judgements evaporated as I have been fully embraced. Mine is a story like countless others.
I believe that all those who share their journeys reap unexpected benefits. For me, there has been something even more important. I now embrace having bipolar disorder. It has allowed me to connect with others in genuine, heart-felt ways and to be part of a wider group of kindred spirits. There is nothing quite so powerful and freeing as authenticity. Being true to who we are requires fortitude and courage.
In my work over the years, I have seen time and time again that men are much more likely to accept their diagnosis if they view doing so as an act of courage. Which it is. So, I would offer this advice to my fellow male travelers: when you are ready, tell your story. We change the culture of silence one conversation at a time. Have the audacity to be part of this long overdue dialogue. You will engender the respect of others in ways that you hadn’t thought possible. When you do, you will see a man staring back at you from a mirror filled with humanity, authenticity and pride.