Author: George Hofmann
It seems that today a man with a mental illness in his middle age is without a voice. So many of the stories told about the struggle with an incoherent mind are from the point of view of the young and mostly female. For so many older men the calls for help from suffering go unexpressed, and, of course, unanswered.
Many people just pass this off, for it has been men who have shaped a world of inequality and privilege, letting little diversity into the government and industry that they control. But the men who bear the brunt and poor outcomes of severe mental illness are not these men. They are not the men of power and influence. Sharing little in common with the stories of mental illness they hear, they feel it’s weak to express themselves and even weaker to seek out help.
As a result, men kill themselves at four times the rate of women, and men account for 70% of all deaths by suicide. While much attention is paid and interventions are developed for teens at risk of suicide, men aged 45-64 die of suicide and overdose much more often. In 2018 nearly 7,000 people under age 25 killed themselves. The same year over 17,000 people over 45 did.
It seems that even doctors pay little attention to suicide risk in older men, as screenings and conversations about what is going on in the patient’s life are not possible with the limited amount of time doctors spend with each patient during office visits. In fact 45% of men over 45 who committed suicide visited their doctor within one month of their death. Their condition went unnoticed.
Over 20% of men with bipolar disorder will end their lives by suicide. The numbers are highest in rural areas.
Why are these poor outcomes highest in middle-aged and older men?
There’s a myth of self-reliance held by men in this group. A belief that one should tough out his problems and a reluctance to talk about them. Reaching out for help is often seen as a sign of weakness.
There’s also easy availability of firearms. Men and women attempt suicide at similar rates, but men are much more likely to use a gun, hence they are much more likely to complete the attempt.
Most impactful of all are the economic changes that have swept the country in recent years. So many jobs in manufacturing and agriculture, jobs most often held by men, have been permanently lost. These jobs, especially in rural areas, are exceptionally difficult if not impossible to replace. Older men are less able and less likely to move and follow jobs. This results, again, especially in rural areas, in skyrocketing rates of opioid dependence and deaths of despair such as suicide and overdose. Hence, the average age of death for a man with bipolar disorder is 56.
There is some promise in the numbers. Treatment effectiveness rates are very high for older adults with bipolar disorder, and older adults are more likely to comply with treatment regimens. Still, we must get men talking.
The power of story is profound. If older men with mental illness can find their voice and share their stories they are less likely to feel alienated and without hope. Role models can be identified and must be given an opportunity to express themselves. Common experience builds trust and hope. This can be accomplished through public health initiatives, churches and community groups.
Stories of assistance can break down the belief that a man must face problems and figure things out on his own. There’s a view that the vision and ideal of the traditional man are under siege, making some men suspicious of the very institutions designed to help support them. If we can appeal to the camaraderie and self-reliance of men in this group with nonjudgmental outreach, listen to their concerns and desires, and create opportunities for productive work we can effect positive change and save many lives.
All sources appear in related articles on my blog “Getting Older With Bipolar.” If you or anyone you know are thinking about suicide, please call the National Suicide Prevention Line at: 800-273-8255.
George Hofmann’s new book Resilience: Handling Anxiety in a Time of Crisis is available wherever books are sold.
After a series of hospitalizations and a lot of bad behavior, George Hofmann managed to overcome the worst of bipolar disorder by adding practices in focused attention to the usual therapies of medicine and talk. He works to show others with anxiety, depression and bipolar disorder how to do the same. He maintains the site “Practicing Mental Illness,” which promotes meditation, movement and meaningful work as keys to growth and healing. George has conducted workshops on meditation for individuals, families, support groups, healthcare professionals and corporations. He lives in Philadelphia, Pennsylvania with his wife, their daughter and two poorly behaved dogs.