Men in Nursing Conference, Mt. St. Joseph University, Cincinnati
Today, I’d like to talk to you about a subject very close to me – the need to overcome the stigma around mental health, especially for young men.
I’ll discuss some of the struggles I’ve faced and how – with the help of faith, family and friends – I finally overcame my reluctance to speak about those struggles and sought the help I needed.
Right now, you may be looking at the screen and wondering what the Little Engine that Could has to do with health issues.
Just bear with me. It’ll become clear in a few minutes.
First, I’d like to tell you about two young men. They were very similar in many ways. Both were studious, shy university students. But there was one crucial difference. The one on the right, Brogan Dulle, took his own life. The one on the left, Santa Ono, tried to do that – twice – but he didn’t succeed.
I was 14 years old the first time I tried to take my own life. I was desperate and I was depressed about how I was doing in school. I’m very grateful I woke up the next day.
Several years later, as a young adult, I again tried to take my life. I was depressed because I had tried to get an experiment to work for several months and it seemed like every single time I tried the experiment wouldn’t work.
I struggled with mental health issues throughout my youth and young adult life, including my years at the University of Chicago, McGill University, John Hopkins University and Harvard University. But I kept those struggles to myself. There was a stigma around mental illness that made me reluctant to seek help.
Finally, I was hospitalized in Baltimore and that’s when things got better. I was seen by individuals who diagnosed me properly and through a period of about a year and a half, I had the appropriate medical support, psychological support.
I was diagnosed with Bipolar Disorder, a mental disorder that affects more than 5.7 million American adults. People who have this disorder experience episodes of depression followed by manic, or overexcited, episodes. In most cases, this is a chronic condition that persists over one’s lifetime. Approximately 20 percent of bipolar individuals attempt suicide. I was treated with a combination of psychotherapy and Zoloft. I think the reason I have been successfully treated (and symptom free for decades) is that I had a mild form of the disease, with hypomania and mild depression. In my case I think maturation, better work/life balance, better nutrition and sleep patterns, and an understanding of childhood stresses were key to my recovery.
For the last 25 years, I’ve been symptom-free. A big part of the balance in my life is that I have a loving family, and they’re there for me.
Not everybody is so lucky. Brogan Dulle for one. As you may know, Brogan was a 21-year-old student at the University of Cincinnati, and a part-time swim coach. He was a wonderful human being.
He left his apartment around 2 a.m. on May 18, 2014, telling friends he wanted to retrieve a cell phone he had lost earlier that evening. He never returned.
Eight days later — after a massive search involving the whole Cincinnati community — his body was found in a nearby building. He had used a crowbar to break into the building where he went down into the basement and hanged himself.
His death affected all of us, the members of the UC community, deeply. We never found out why he took his life or what was troubling him. His parents, his four brothers and his sister are still searching for answers to that question.
I want to ensure that does not happen again, that the Brogan Dulles of the world get the support they need to lead healthy and fulfilling lives.
Which brings me back to the little engine that could.
When Brogan was teaching kids how to swim, he would often tell the story about the little engine that could, to encourage them to do their best. As Brogan said, we are all little engines that can. But for some of us — especially people suffering from mental illness — the hills are that much steeper, and sometimes we need help to get up those hills.
But to get that help, we need to remove the stigma around mental health.
If you get the flu, or break a leg, you don’t hide your illness or injury — you seek medical aid, as I did during my own medical crisis, which I’ll get to in a minute. But if you’re mentally ill, you’re less likely to seek help, because of that stigma — the sense that mental illness is something to be ashamed of, that it’s your fault.
I wanted to change that. To take the stigma away from mental illness, to make it normal. After Brogan’s death, I became more outspoken about my own experiences, hoping that my example would help others realize that they’re not alone and that depression is nothing to be ashamed of.
I was far from the only one. Brogan’s family, for example, started an organization called 8 Days of Greatness, in tribute to the eight days during which the people of Cincinnati came together to search for Brogan. I am humbled by their courage and how they turned such a traumatic experience into something positive. As I reflected on their efforts, and on my own experiences, I realized that one of the biggest hurdles is overcoming the stigma around mental health.
And it’s especially hard for men. For my generation at least, opening up about illness – especially mental illness – is difficult for men. As a male, you’re supposed to be stoical, to suffer in silence. This is not right.
As Rob Whitley noted recently in Psychology Today, “there is a silent crisis in men’s mental health.” Men make up over 75 percent of suicide victims in the United States, with one man killing himself every 20 minutes. The rate is especially high among veterans, young American Indians and gay men, groups that may feel marginalized. Men are also more likely to be substance abusers – the rate is 3 to 1 in comparison to women. Substance abuse, Whitely notes, is sometimes referred to as “slow-motion suicide,” given that it can often end in a premature death for the person concerned.
As the National Institute of Mental Health notes, men and women experience many of the same mental disorders but their willingness to talk about their feelings may be very different. This is one of the reasons that their symptoms may be very different as well. For example, some men with depression or an anxiety disorder hide their emotions and may appear to be angry or aggressive while many women will express sadness. Some men may turn to drugs or alcohol to try to cope with their emotional issues.
Sometimes mental health symptoms appear to be physical issues. For example, a racing heart, tightening chest, ongoing headaches, and digestive issues can be a sign of an emotional problem. Men suffer from these problems at similar rates to women, but are far less likely to seek help.
I can attest to that. I found it very difficult to talk about my struggles. I felt ashamed to speak up.
Why are we as men so reluctant to ask others for help?
One reason is that men don’t feel comfortable talking about emotions. Because of stereotypes about masculinity, men are afraid they’ll seem weak if they talk about feelings, emotions or mental states. And, unfortunately, sometimes with good reason.
According to a recent Australian study, three out of four men reported experiencing stigma as a result of their mental illness, leading to:
- Misrepresentation in the media
- Reluctance to seek or accept necessary help
But, with the efforts of people like the Brogans and others we can change that. There are many people, many organizations, working to take the stigma out of mental illness and to help those who suffer from it. To help us get over those hills
1N5 is one example. Its name refers to the proportion of teenagers who have mental health conditions – one in five. 1N5 hosts an annual event to raise awareness and bring mental health education to schools here in Cincinnati. It was founded by Nancy Miller after her own husband committed suicide.
I was privileged and humbled to speak at one such event, where I was preceded on stage by a young woman named Jasmine Warga.
Jasmine had lost a good friend to depression. But she turned her experience into a best-selling book, My Heart and Other Black Holes. Jasmine shared her story, but more importantly, her insights. I’d like to share some of them with you in turn:
- Depression is real. It is as real and prevalent as any other disease that presents in a more physical nature and we need to take it just as seriously.
- Depression will convince you that you are unloved when in reality you are deeply loved and it will convince you that you are alone even when you are surrounded by friends.
- There are bad days, but there are also days filled with love and laughter and sunlight.
- We need teenagers to understand that you can have those really bad days but live a meaningful and good life. We need them to know that they are not alone.
Powerful words. You can read more of Jasmine’s story and her insights in her book.
Young people such as Jasmine give me hope that the world I imagine — one where young people suffering from mental illnesses can speak freely about their condition and get the help they need — is within reach.
Before I close, I’d like to give you some insights into why I hold your profession – and other medical professions – in such respect.
It’s not widely known that at the age of 36, I experienced a significant health scare. At the time I was an Associate Professor at Harvard Medical School with my laboratory, which was based at the Schepens Eye Research Institute, near the Massachusetts General Hospital. I had just received a major NIH grant and my wife Wendy had given birth to our first daughter, Juliana. We were happily setting up our first home. Wendy was active practicing law and frequently travelling to national conferences. We were fortunate that Juliana had a wonderful daycare provider, Donna English.
One Friday when Wendy was away, I had just finished lecturing and I felt unusually exhausted. I was meant to drive from Brookline to pick up Juliana in West Newton. But I found that I could barely make it to my car and had problems lifting my legs into the driver seat. Somehow I was able to get the car moving and to begin my trip against heavy traffic. But I became increasingly weak and had problems even turning the steering wheel.
As I was about to pass my house in Newton Centre I knew that I was in significant trouble. The weakness in my arms and legs was alarming and I wasn’t sure that I could make it all the way to West Newton to pick up Juliana. Fortunately I was able to call Donna and she said that I should go home and call her when I was well enough to pick Juliana up. She said I could even wait until Saturday morning. I was barely able to crawl into the house and collapsed onto the floor. I was so exhausted that I fell asleep and didn’t wake up until the next morning. When I did wake up, the phone was ringing. It was Donna, wondering if I was okay. I asked her to bring Juliana to the house because I wasn’t well enough to drive to pick her up. About an hour later Donna and Juliana showed up at my house. Although Donna was very worried, I convinced her I was well enough to take care of Juliana.
Later that day I became even more fatigued and was there alone in the house with a one-year-old daughter. My fingers and toes became very numb and I was having trouble seeing properly. Remarkably, I remember vividly that Juliana, despite being only a toddler, showed tremendous empathy towards me, knowing that I wasn’t well.
Wendy returned from out of town on Sunday and I told her that things were not well. She drove me to Brigham and Women’s Hospital and I was immediately referred to a neurologist. After a battery of tests, I was hospitalized and became a guinea pig for neurology residents and medical students. They took spinal taps and performed EMGs and returned with the diagnosis that I was suffering from an acute onset demyelinating disease. They didn’t think it was guillain-barré syndrome but needed further testing to determine whether it was MS. Ultimately, the feeling was that it was a post infectious, rapid demyelinating disease. We would have to wait and see if this would be a chronic/relapsing condition or an acute episode. At its worst, I was barely able to lift my arms and legs and was bedridden. It took me quite a bit of time to transition to a wheelchair and then to learn how to walk again.
I will be forever grateful to my colleagues at Schepens and at HMS who told me that I should take as much time as possible to get better. I’ll never forget the first lecture I attended after returning to the university. As I made my way slowly to my seat, the entire audience stood up, turned towards me and gave me a standing ovation. I’ll never forget the kindness of my colleagues at Schepens and Harvard.
Although I had to be placed on systemic steroids and tapered off twice, I eventually regained my strength and have remained symptom-free now for nearly two decades. But for about a year, I didn’t feel quite right and would tire easily. I was horrified that I might experience a relapse and worried if I’d be healthy enough to raise Juliana.
I made it through those dark days, with the support of friends and family. I took one day at a time and regained my strength. By the grace of God, I was able to go back to work and to continue my life and career.
This health scare had a real impact on me. It made me appreciate simple things such as being healthy and being able to walk; watching the sun rise and sun set; listening to birds sing; enjoying the laughter of my daughters and their friends. And it gave me an increased appreciation for the selfless men and women who work in the health care sector. People like you.