How more men can feel better

Within weeks of returning from a tour of duty in Afghanistan, Jason Kander knew something was wrong.

He was having nightmares. He was hypervigilant. He was emotionally numb. And was full of shame and self-loathing.

“At some level, I think I knew I had PTS [post traumatic stress],” Kander tells Inverse, “but I was unwilling to acknowledge it even to myself.”

Living through a pandemic isn’t exactly like going to war, but both traumatic events are absolutely rattling to a person’s mental health.

Here’s how Kander got through it — and how more men can get support to categorically improve their lives.

According to the Kaiser Family Foundation, during the pandemic, one in four adults reported “symptoms of anxiety or depressive disorder,” up from one in ten the previous year.

This surge is especially concerning for men, who have the statistics piled up against them: In 2019, the CDC found that 7.2 percent of men had gone to therapy. The number was 11.7 percent for women, a 4.5 percent difference.

Let’s unpack those stats for a second: There are 161 million men in the United States, and 4.5 percent of that population is 7.2 million men. That’s the entire Dallas–Fort Worth metropolitan area. Imagine that many more dudes going to therapy to help them be better for themselves and the people around them.

So, how do we — how do you — get there?

David Reiss, a psychiatrist and trauma expert, tells Inverse that the issue is largely cultural.

“Statistically, for cultural, not biological, reasons, men are less able to connect emotions with behaviors,” Reiss says. He adds that it’s also likely “due to the persisting ‘macho’ stance that emotional problems or seeking help are evidence of ‘weakness.’” Reiss adds that these mentalities differ across different cultural demographics and communities and won’t apply to everyone.

Some men do not seek help because they believe what their problems do not require therapy. This was one of the challenges for Kander.

“I couldn't have PTS because I ... didn't believe I had done enough to earn it.”

“I couldn't have PTS because I — like many combat veterans, it turns out — didn't believe I had done enough to earn it.”

Kander was also reluctant to go to therapy because he didn’t want to focus on the thoughts he’d been trying so hard to push away.

“I was hesitant about therapy for the same reason I'd been staying busy and trying to outrun my own mind,” he says. “It wasn't a pleasant place to spend time.”

Kander says his mental health continued to worsen.

The problems came to a head at the most inopportune of times. It was in the thick of the Kanas City mayoral election, a contest he was widely expected to win.

In a letter posted on Facebook at the time, Kander wrote that he was dropping out of the race, adding:

“After 11 years of trying to outrun depression and PTSD symptoms, I have finally concluded that it’s faster than me. I have to stop running, turn around and confront it.”

Kander then reached out to Veteran Affairs and began getting help there regularly.

When to consider therapy

Reiss says there are a few signs that one should go to therapy:

• The sign that requires immediate attention is the emergence of dangerous behavior – violence toward self or others, self-harm, unwarranted risk-taking, substance abuse, etc.
• Difficulty functioning in your daily life: If you’re not showing up to work or suddenly getting in a lot of fights with your friends or significant other, routinely blowing off that Sunday night check-in with mom.
• Problems with sleep, appetite, concentration, or attention that last for more than a few days.
• Experiencing distress that is out of proportion to actual events or does not resolve even when objective stresses lessen. If you find yourself enraged by making a small error at work or still burning with shame over an embarrassing encounter in the grocery checkout line a week ago, that might be a sign to look into therapy.

What to expect from therapy

Therapy can be intimidating. It’s completely understandable that talking with a stranger about your feelings — especially when you might not even know how you’re feeling seems less than appealing. But try to remember, this is a therapist’s whole job. It’s what the person the therapist saw before you did, and it’s what the person the therapist will see after you will do. Also, they’re trained in how to ease you into the process and make you comfortable.

And there’s a chance that therapy is going to be different from your expectation.

Part of Kander’s therapy involved Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy, which is often used with veterans or others experiencing PTSD.

While he says that treatment has given him the tools to manage his symptoms and keep them from disrupting his life, it was hard work.

“My biggest misconception about therapy was that it would just be passively talking about Afghanistan, like getting an IV drip or something,” Kander says. “But it wasn't passive at all. It was more like physical therapy or graduate school.”

“That’s what I learned: therapy is work.”

“No one just gets better,” Kander adds, “You have to commit to doing the work of getting better.”

How to find a therapist

What kind of therapy is best? Reiss says it “largely depends on the needs of the individual, the nature of the problems/symptoms and the ability of the person to respond to different types of therapy.”

For example, it wouldn’t make sense for someone who hadn’t experienced trauma to do prolonged exposure therapy. Most people start with cognitive behavioral therapy and go from there.

Reiss says one silver lining of the pandemic is that it’s made telehealth much more common. People who don’t have access to a therapist in their immediate vicinity. Reiss prefers in-person sessions, but says “teletherapy is far better than no therapy, and often just about equally as effective as in-office treatment.”

• If the first person you meet with isn’t fit, that’s OK. Keep looking. It’s very common for people to try a few therapists before finding the one that works for them.
• Some therapists will offer a sliding scale based on what you can afford.
• Be sure to ask if that’s an option.

While men may be less likely than women to go to therapy if 7.2 percent of the adult male population of the United States is going to therapy, that means you’ll be in the company of roughly 7,271,594 other men. Or you know, about the population of the DFW metro area.

Kander’s best advice: Don’t worry about if what you’re feeling is “bad enough” to require therapy.

“My brain doesn't know what your brain went through, and your brain doesn't know what mine went through,” Kander says. The bottom line, he says, is the growth that can come from getting help “is worth it.”

Therapy resources

• Psychology Today’s Find a Therapist website lets you search for therapists in your area by insurance and see if they offer a sliding scale.
• GoodTherapy.org also lets you search for therapists in your area and by sliding scale.
• Open Path Collective is a non-profit nationwide network of mental health professionals that provide therapy at a steeply reduced rate for in-person (probably post-pandemic) and online options.
• The Substance Abuse and Mental Health Services Administration website can help you look up treatment options for, as you may have guessed, both mental health and substance use issues.

Detox is an Inverse series that answers the biggest questions about men’s mental health.