Lthan year, I read Of Boys and Men by Richard Reeves. In his research, Reeves outlines several factors that lead to boys and men feeling excluded from society and failing through various systems, whether it’s education or the workforce. One section says how men struggle after divorce or relationship endings, especially if they don’t get back together. None of this information is new, but it made me look at the increasing number of referrals from men sent to my clinic each week.
Many men are socialized to prioritize strength, independence, and stoicism, making it difficult for them to open up and form emotional connections. Many aging men experience loneliness due to the loss of a partner and friendships. The following is an example of the types of cases I see regularly in my clinic.
Colin* is a 49-year-old sales manager with bipolar disorder who presents to the mental health unit after a five-week admission for mania secondary to medication non-adherence, alcohol abuse and a recent separation from his wife. During his most recent manic episode, he had an affair with a work colleague and was subsequently suspended by his employers. Colin was facing significant work stress with upcoming deadlines. He reduced his medication without discussing it with his doctor. He thought that he would work more effectively as he found that mood stabilizers and antipsychotic medications were calming. Unfortunately, this led 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 led to an involuntary mental health assessment where his medication was reinstated.
When I met Colin, he was living alone in a short-term rental. After learning of the affair, his wife asked for a divorce and he was forced to leave the family home. Colin had a previous relationship and this is the fifth manic episode over the course of their 30 years of marriage. His two grown children have sided with their mother and Colin feels unsupported. “It’s like I’ve been left out in the cold,” he says. “However, I need their support now.”
His work was more forgiving as he is one of their top performing employees; however, they want him to see a psychiatrist and develop a return-to-work plan.
Colin is motivated by his children who keep in touch, albeit at a distance. He agrees to attend regular AA meetings and group therapy. He knows he has to take his medication 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 were far from the relationship. I inquire about work colleagues and he says that despite many years with 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 undue stress on the family when he does not take his medication. When I ask about Colin’s wife, Adam is not optimistic about their chances of getting back together. “She had enough of him.”
Despite all this, Colin generally seems upbeat, but comes across as a lonely person. He takes his medication, attends group therapy and his return to work is initially uncomfortable but successful. We agree that he attends part-time work for a few months to reduce stress. Colin still lives alone but talks to his wife and is hopeful for a reconciliation. We schedule a review in two months. Colin misses this appointment and sends an email apologizing but not providing context or rescheduling. Two weeks later I get a phone call from a police officer saying that Colin killed himself.
Adam comes to the clinic and thanks me for the support. He grieves for his father but also seeks answers. He confesses that he feels he has failed Colin. Adam says he came to pay the fee for his father’s appointment. I tell him it won’t be necessary. I assume that the real reason was that he wanted to talk to someone about his father, someone who knew him before the end. Adam is tasked with organizing the funeral as his younger sister and mother are too overwhelmed with grief. It was difficult to find friends of his father to attend the funeral. Adam hastily says goodbye and apologizes for taking up my time. I see similarities in father and son – two men trying to keep it together.
Mental health services try to engage lonely men with various strategies. We know that most men do not call helplines when they are in crisis, many struggle with individual therapy and men only group therapy is not readily available. Governments are discussing policies to have interventions targeted at boys in schools. Holistic practices such as exercise (gym, running or sports), a healthy diet and good sleep hygiene also help, but they are not enough. I am optimistic that we will get there, but it is sometimes bird as if nothing changes while men struggle.
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 National Suicide Prevention Lifeline on 988, chat further 988lifeline.orgor SMS HOME to 741741 to connect with a crisis counselor. Other international helplines can be found at befrienders.org
*Patient samples are amalgamations of people often seen by psychiatrists