It was like any other morning at Civil Hospital. Ahmad* made his way amid the regular hustle and bustle to the psychiatry ward for his second last rehabilitation session. But that day something was different. There was a new face, a stranger such as me in the room. Throughout the session, Ahmad’s right foot shook as he avoided making eye contact with this unfamiliar, external presence.

Ahmad has been suffering from social anxiety disorder for almost 10 years. Until recently, he used to express his anxiety through extremely aggressive and agitated behaviour. But last year, his sister realised that the excessive anger and behavioural problems were a symptom of some other underlying cause, and took him to a mental health specialist.

Despite treatment and showing considerable progress, Ahmad dreads talking openly about his illness with friends or even the extended family.

The macho attitude of stuffing your feelings down or ignoring them is antiquated and downright dangerous for men’s mental health

“It’s a secret from my friends and family,” says Ahmad, “Mujhe lagta hai agar unhein pata chal gaya toh woh mera mazaaq urrayein ge [I fear that if they get to know about my illness they will make fun of me].”

Ahmad is not the only one.

Some time back, a video appeared on social media of a boy jumping off the fourth floor of Centaurus Mall in Islamabad. Despite denial by the family, it is speculated that the boy committed suicide because he had been a victim of persistent bullying for not having a masculine voice.

Recently, many cases of suicide have been reported; some even in holiest of all places, Makkah. They left us shaken to the core, as they show that suicide among men is on the increase.

According to the Karachi Mental Health Report (KMHR) published in 2012 — one of the few reports about the mental health of Karachiites — far more men than women commit suicide in Karachi, the exact ratio being 6.1:1. These statistics correspond with the suicide rates reported across the globe where more men die by committing suicide as compared to women.

Men, just like women, suffer from everyday life pressures too. Contrary to the common perception, men too have gender roles assigned to them by the society they live in, which may or may not align with their circumstances or physical and mental disposition.

In a patriarchal society such as Pakistan, men face the pressure of being the head of the family. Self-reliance and resilience are the default traits assigned to a ‘man’ by society and anything that contradicts this stereotypical image is deemed incompatible with masculinity.

According to the Karachi Mental Health Report (KMHR) published in 2012 — one of the few reports about the mental health of Karachiites — far more men than women commit suicide in Karachi, the exact ratio being 6.1:1. These statistics correspond with the suicide rates reported across the globe where more men die by committing suicide as compared to women.

“Social roles of men are demanding and challenging, and yet everyone has a different capacity to deal with such pressures,” says Anila Mukhtar, a psychologist. “Men may experience a sense of defeat in circumstances that they perceive to be extreme and uncontrollable.”

Adding to the pressure are gender norms which discourage men from sharing and seeking help from family and friends regarding any emotional problems or mental health issues that they might be facing. Instead, men choose, and are often encouraged, to stay strong and ‘in control’ by masking their internal emotional disturbances with external anti-social, impulsive and risk-taking behaviours. The widespread belief and acceptance of the idea that aggression is part of men’s nature, makes the situation even worse.

Noman*, a 50-year-old, lower middle-class man diagnosed with schizophrenia, has, over the years, internalised these expectations to the extent that he takes pride in being feared by his children and daughter-in-law. He denies that his extreme strictness and intimidating behaviour with family members is a sign of emotional instability and instead suggests that aggression runs in the family because his eldest son and even a two-year-old grandson show similar behaviour.

The findings of the KMHR report also corroborate this explanation. It suggests that more male children in Karachi show disruptive behaviour and behavioural issues as compared to their female counterparts.

Another gender expectation associated with men is that they are the breadwinners. So along with staying in control, men are also expected to stay in charge. In light of her experiences as a mental health practitioner, Alizeh Valjee, co-founder of CareForHealth says that even though men seek treatment more than women in a psychiatric set-up, the burden to earn and provide for the family often leads them to abandon the therapy cycle in the middle.

Valjee says, “Men who come for treatment are under pressure to recover quickly and they often have to choose between keeping their therapy/doctor’s appointment and going to their job. Sometimes being unable to provide for the family can also be a big environmental stressor or trigger.

“When people start realising that they are equally susceptible to developing a mental illness because they too have accumulated trauma and/or may have a genetic predisposition, it stops being about ‘them’ and becomes about ‘I’,”she adds.

Pakistan, with its meagre 0.8 percent of GDP expenditure on health has a really long way to go when it comes to mental health issues of both men and women. The key to understanding mental issues is that we are all prone to mental health issues at some point in our lives.

• Names have been changed to protect the identity of the people

Published in Dawn, EOS, August 5th, 2018