On Thursday, the bruised and tearful face of former footballer and chairman of the Professional Footballers’ Association, Clarke Carlisle, 35, appeared on the front page of the Sun. He was released from psychiatric hospital two weeks ago. In a clip on the paper’s website, he appears so raw and vulnerable that to watch it provokes thoughts of a modern-day version of Bedlam with us as Hogarthian gawpers treating the mentally fragile as entertainment. The paper’s headline read: “I leapt in front of a lorry hoping to die.” Carlisle, a father of three, has suffered from depression for 18 months. He explained that the end of his career, the curtailment of his contract as a TV sports pundit and a struggle with alcohol led to financial problems. He felt the lack of “a sense of worth and value in life”. He said strangers would comment: “Didn’t you used to be Clarke Carlisle?”, as if, once off the television screen and football pitch, he had passed into no-man’s-land. Throwing himself in front of a lorry became the “perfect answer”. Carlisle survived, unlike 12 men who will kill themselves today, as 12 do every day, in England and Wales. Just before his death, the psychiatrist Anthony Clare wrote a thoughtful book, On Men: Masculinity in Crisis. He concluded with a plea to men to place “a greater value on love, family and personal relationships and less on power, possessions and achievement… to find meaning and fulfilment”. Except that redefining what it means to be a man in contemporary society isn’t a job for men alone. It’s a dynamic process of cultural and social change that repeatedly judders to a halt. And it will continue to be impeded for a variety of reasons (better the stereotype you know) and as long as some women hold fast to a hierarchy of need. This is the kind of thinking that says: if male fragility is addressed, women’s requirements are marginalised. Men can hog resources, but the two requirements are interlocked. Until male violence can be defused, for instance, the refuges will continue to overflow.
In the main, support for Carlisle’s honesty has been strong, as it has been for Nick Baber, 48, chief operating officer at KPMG, who last week said he would pretend he had flu during severe depression. He has called for more senior executives to speak out. But then what? As Dr Margaret McCartney explains in The Patient Paradox, the severely depressed are too ill to make plans to end their life. When a patient is beginning to recover, suicide becomes an option, particularly if they are male. Thoreau wrote: “The mass of men lead lives of quiet desperation.” Talk to parents from Papyrus, the charity that campaigns to prevent young suicide, and again and again they say they had no idea that their sons were depressed, let alone suicidal. Their sons, they felt, had so much to live for. According to the charity, Campaign Against Living Miserably (Calm), men account for more than three-quarters of all suicides in England and Wales, 4,590 deaths – the single biggest cause of death among males under 50. Three out of four had no contact with mental health professionals. As the Men’s Health Forum constantly points out, men are reluctant to go their GP and fail to identify their own symptoms of depression. When Carlisle’s wife, Gemma, was diagnosed with postnatal depression, he advised her to “get a grip”; then he took Goldberg’s depression test and recognised his own symptoms. They include lack of energy, sadness, negativity and self-destructiveness. A survey by Calm revealed that 69% of men said they preferred to deal with problems themselves, 56% didn’t want to burden others. “The traditional strong silent response to adversity is increasingly failing to protect men from themselves,” said Jane Powell, Calm’s chief executive. Last year, the charity issued a much-needed four-point charter to encourage change for the better. It includes a shift in thinking about the needs of males in schools, work and public services and a fuller range of expression of masculinity in the media and advertising. Too often, still, while depression in women is wrongly viewed as an inevitable part of being female, it’s precisely this alleged association with female fragility that underscores the notion that the male sufferer is less of a man; he has a weakness, not an illness best kept secret. So, as the suicide rate has risen, the taboos and social “norms” stay in place. Change, however, is possible. Last month, a new policy on suicide prevention was launched, the Stop Suicide pledge. It is based on the work of Dr Ed Coffey in Detroit that enrols as many members of the public as possible with the aim of ending the stigma and the secrecy. In four years, the suicide rate dropped 75%.
The UK “zero suicide” pilots ask the whole community to look out for each other, recognise warning signs and offer help, not exclusion. The pledge, with a badge, is, “I’d ask”. (Although what you ask is trickier. “Is everything OK?” is bound to get a positive response in a well-trained man.) The New Economics Foundation says the five foundation stones of wellbeing are: connect, be active, take notice, keep learning and give. The female sphere, even when it involves working 10 hours a day as well as mothering and acting as a carer, has all those aspects woven into it (and paradoxically at extremes can be the cause of female depression and breakdown). The male stereotypes of protector, provider, toughie and top dog shoves wellbeing well down the list. Kurt Cobain, desperately in need of help for years, in his poignant suicide note to Boddah, his imaginary childhood friend, quoted a Neil Young song: “… better to burn out than fade away…” The tragedy for too many men is that society doesn’t yet allow them to let down their guard so they can value and enjoy the infinity of choices that lie between those two extremes.
This article first appeared The Guardian, 8 February 2015.