We need to talk about anxiety in men

Do you think we need to talk about anxiety in men?

Coloured image of man with squiggly lines come up from his, appears to be experiencing anxiety
Anxiety in men is real — Image from Irishtimes.com

An article by Madeline R. Vann, MPH caught my eye recently. She wrote: “Anxiety disorder in men is real and treatable through therapy and medication.” She’d written about a young man who, although aware he’d had anxiety since childhood, he never actually tackled it until well into his twenties. I just thought, what a long time to suffer. This, and the fact that it’s Men’s Mental Health Week, is why I think we need to talk about anxiety in men.

So what is anxiety?

Black and white image of young women head down and sitting on a bench. Green writing says what do you know about anxiety - Mental Health 360
What do you know about anxiety?

Anxiety is a type of fear usually associated with the thought of a threat or something going wrong in the future, but can also arise from something happening right now.

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe, according to the NHS. Everyone has feelings of anxiety at some point in their life. For example, you may feel anxious about sitting an exam or a job interview. During times like these, feeling anxious can be perfectly normal but some people find it harder to control their anxieties. Their anxiety is more constant and can often affect their daily lives.

Anxiety is a feeling that lets us know when we might be in danger, at risk or under threat. However, anxiety disorders occur when our fears and perceptions of danger are greater than they need to be.

The following information from the NHS is about one specific condition called generalised anxiety disorder (GAD). GAD is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event. People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.

Symptoms of generalised anxiety disorder (GAD)

GAD can cause both psychological and physical symptoms. These can also occur in other anxiety disorders but for brevity, we’ll just talk about GAD. These symptoms vary from person to person, but can include:

Cartoon man shaking and sweating with anxiety - quoting symptoms of anxiety
Symptoms of generalised anxiety disorder
  • feeling restless or worried
  • having lots of negative thoughts, feeling guilty, angry or shame
  • having trouble concentrating or sleeping
  • dizziness or heart palpitations
  • feeling like you’re having a heart attack – if you suspect heart attack, seek urgent help
  • sweating, sticky palms
  • shaking
  • fidgeting or pacing
  • feeling faint
  • feeling like you can’t breather, choking
  • fingers or toes tingling (this happens when the blood runs from your extremities to your heart and muscles, where it’s needed to prepare for fight or flight

What causes anxiety disorders?

The jury’s out on this one. The exact cause is not fully understood, tho’ it’s likely that a combination of several factors plays a role. Research has suggested that these may include:

Black and white drawing image one of brain and the other side in colour
Does over-activity in the brain cause anxiety
  • over-activity in areas of the brain involved in emotions and behaviour
  • an imbalance of the brain chemicals serotonin and noradrenaline, which are involved in the control and regulation of mood
  • hereditary – you’re more likely to develop an anxiety disorder if you have a close blood relative with the condition
  • having a history of stressful or traumatic experiences, such as domestic violence, child abuse or bullying
  • a painful long-term health condition, such as arthritis
  • having a history of drug or alcohol abuse
  • but many people develop anxiety disorders for no apparent reason.

Who is affected by anxiety?

Absolutely anyone. You might’ve noticed someone constantly drumming their fingers or tapping their foot annoyingly? Maybe you’ve seen that irritating colleague who constantly fidgets during meetings or spits out the nails she’s chewed for the last half hour?

Anxiety in me

Coloured image of a large community swimming pool and auditorium
Anxiety in women — image by featurepics.com

I’ve experienced mental health problems, including anxiety and I know how horrendous it feels (you can read it here). The dread when going to watch my sons swimming because of the steep seating area. I hated all those stairs looking over the pool and had a terrible fear of tumbling down them all. I’d start to sweat in fear, and my heart would be pounding through my heart and in my ears. It was the same in the cinema, those damn stairs, and in the dark!

Tube stations soon became a problem too, the further down the escalator went, the more anxious I got. (Hence my love of driving and the famous London black taxis.)

Diagram of circle with thoughts, feelings and behaviour written on it
Vicious circle of anxiety

See, the thing with an anxiety disorder is that once you’ve had a panic attack, you get anxious about being anxious. You only have to think about, let’s say, the tube station, and your anxiety levels shoot through the roof. And then it becomes a vicious circle of thoughts, feelings, behaviours.

Take a look at the diagram. You might have the thought “I’m dreading the tube station,” and you begin to feel anxious, so you avoid the tube (behaviour). After this, you might think “I’m so weak,” and feel sad, alone, angry…….. and so on…….

Anxiety close to home

Coloured image of male standing with hands on his hips, wearing a karate black belt
Black belts can have anxiety – Image by jahir-martinez-unsplash

My two adult sons experienced anxiety and panic attacks in the past. They’re both black belts in Karate, they’re club swimmers and play football each week.

So, although they both claim to be geeky in a science-type way, they’re not weedy or wussie; nor do they come across as lads who’d have anxiety.

Some family and friends have been shocked, like “Wow, I didn’t think they’d have mental health problems.” and “Never? I’m really surprised.”

Several younger male family members were encouraged by this and sought support themselves, with some having gone into talking therapy. They’ve all said they’re so glad they did.

So, what I’m really saying here guys is, it doesn’t mean you’re a weak person, anyone can experience anxiety. It doesn’t care where you’re from, what class, faith, creed, race, gender you belong to or what job you do.

Anxiety statistics

Coloured image of young woman standing by a window, looking out anxiously and biting her nails
The anxious and pacing nail biter
  • In 2013, there were 8.2 million cases of anxiety in the UK.
  • In England women are almost twice as likely to be diagnosed with anxiety disorders as men.
  • the condition is more common in people from the ages of 35 to 59.
  • 5.9% of people suffer with a generalised anxiety disorder.
  • mixed anxiety & depression is the most common mental disorder in Britain, with 7.8% of people meeting criteria for diagnosis.
  • 7.2% of people aged 5 – 19 have been diagnosed with an anxiety disorder
  • In 2017 13.1% of people aged 17 – 19 had an anxiety disorder

As you’ll have noticed, anxiety and depression are closely linked so if you have one, you’re more likely to be experiencing the other. You might also find that some form of agoraphobia, a fear of doing certain things, or going to certain places quite often occurs with anxiety.

How is anxiety disorder treated?

Anxiety disorders can have a significant effect on your daily life, but several different treatments are available that can ease your symptoms. These include:

Colour image of scrabble saying recovery
Recovery from anxiety — image from Psychcentral.com

With treatment, many people are able to control their anxiety levels and lead normal lives. But some treatments may need to be continued for a long time and there may be periods when your symptoms worsen.

Self help for generalised anxiety disorder (GAD)

Colour image a man wearing blue t shirt and shorts on a cycle with back wheel up in the air
Exercise for anxiety – Image by Pexels at Pixabay.com

There are also many things you can do yourself to help reduce your anxiety, such as: 

  • reading a previous post 19 free mental health apps just for you here
  • or Tips to help with your anxiety and panic attacks here
  • attending a self-help course in person or online
  • exercising regularly
  • stopping smoking
  • cutting down on the amount of alcohol and caffeine you drink
  • trying 1 of the mental health apps and tools in the NHS Apps Library

Over to you

Clipart.com

When it comes to talking about mental health problems, do you think it’s necessary to separate the men from the women? Or should we just be inclusive and talk about mental illness as a whole? What about the men; should they just man up? I look forward to your thoughts and comments, and of course, I’ll answer any questions.

Mental Health rehab works—only if the staff do

Realkm.com

While I was a student on the rehab unit I had to complete my Practice Based Assessments (PBA’s) and I’d chosen four patients that I could work with to meet these over the twelve weeks placement. First there was Mandy who had Generalised Anxiety Disorder (GAD) and next was Sasha, Elsa and Edward who all had a diagnosis of chronic schizophrenia.

Mandy

I spent many pleasurable weeks working with Mandy, the lady who’d previously screamed for her medication several times a day. She repeatedly said that she could notice the reduction in each nought point five mg Diazepam, which was highly unlikely. However, I appreciate that for her, it was difficult, hence her continuous screeching at medication time.

From my parenting days, I knew that distraction worked well when children were upset so I hoped distraction might help Mandy too. I would offer her a cup of tea and ask what her plans were for the day or about her collection of teapots, rather than have the poor lady screaming and working herself into a panic attack.

It’s a shame that other nurses hadn’t picked this up as it would have been far easier for them in the long run and certainly better for Mandy. However following discussions with her Primary Nurse, the nurse who has overall responsibility for a patient, her care plan was updated and read “When Mandy is upset and screaming her allocated nurse must use distraction techniques.”

Example care plan
How a care plan might look

Care plans are prepared for each patient and wherever possible, are developed with the patient, rather than for the patient. The care plans are used to guide your practice with patients, to explain what care is required and how to carry it out.

As she got better, Mandy would eventually accompany me to the local Primark to get cheap knickers. Grinning cheekily, she would say the money she saved from buying these allowed her to buy her favourite yoghurts from Marks and Sparks next door. Once I’d left the unit it always cheered me up when I saw Mandy and I loved to stop for a chat.

Sasha

I had a lot of fun working with Sasha; she was witty, intelligent and was becoming much more cheerful as the weeks went on. Between us we managed to clear all the cereal boxes from her room along with the crumbs and mouldy, congealed leftovers we found in bowls under her bed.

This wasn’t my favourite task but I laughed all the way through it because Sasha was getting really cheeky. When I was busy scrubbing the floor she’d sit on her bed reading or stand at the window waving at random passersby and she’d crack up when I spotted it.

Many of Sasha’s care plans were updated or changed altogether now because she’d made great progress in several areas and some of her care plans were now outdated. One care plan read ‘Encourage Sasha to keep her bedroom tidy and work with her if necessary. If Sasha refuses, staff to advise her that they have a duty of care to ensure her environment is clean.’ It was like writing instructions for nine year olds rather than senior qualified nurses.

Another care plan read ‘Encourage Sasha to spend time off the unit and accompany her if needed.’ I loved spending time with her in the cafe, a local haunt for both patients and staff. I always took my badge off when accompanying patients outside as I wanted them to feel equal in the community. It really bugged me seeing staff wearing badges when outside with patients. It was like ‘them and us‘ and showing the staff member was in a position of authority, which I thought was unfair.

Elsa

At forty eight Elsa hadn’t aged well at all; she originally came from Greece and her face was craggy from the sun. She had short wiry grey hair which she hacked at herself, staring in the mirror taking great clumps out with almost blunt scissors. These were eventually taken from her as she’d often say to fellow-patients and staff “I will kill you.” She did this with a wicked grin so I didn’t think she was really serious but the scissors might have posed a risk to both her and others.

One of her care plan was updated and read ‘When Elsa wants to cut her hair, a staff member must be with her and remove the scissors back to the office once finished.’ I wanted to find out why Elsa chose to use her clothes as toilet paper but, despite using one of our translators, she just shrugged and grinned when asked. However, it was something we had to work on, we couldn’t just ignore it. I asked several staff nurses what has been tried in the past and what worked but was told “That’s just Elsa. She always does it and nothing works.” Elsa had been on the unit for months and nobody could tell me what had been tried.

When I was on duty as a nursing assistant (NA) or there on my student placement I tried to speak with Elsa every couple of hours to see if she needed the bathroom. I tried taking her to the toilet, getting her to sit for a while to see if she would poop, her favourite word. Sometimes it worked and I had to wait while I encouraged her to use toilet paper. “Too small.” she would grin “No enough.” and she’d try to use her skirt. Ah! Next time I accompanied her to the bathroom I took a roll of the large hand drying paper. Success!

NMC.org.uk

One of her care plans was updated to read ‘Encourage Elsa to use the toilet throughout the shift and have hand paper available.’ though I know this rarely happened as I never saw it documented. The Nursing & Midwifery Council (NMC) Code of Conduct states that ‘nurses should respect, support and document a person’s right to accept or refuse care and treatment.’ It did not say ‘if patient refuses support, just leave it at that.’

Once my placement ended I would later hear that Elsa had reverted back to using her clothing to wipe herself. I was truly mad that the nurses had allowed this to happen. It was like they’d given up caring and they were just passing time until retirement. However, I did learn how not to nurse and their disassociation made me even more determined to be a good nurse. Our patients deserved better.

Edward

Edward had long been on a medication called chlorpromazine, the first antipsychotic which was widely shown to be significantly more effective than later antipsychotics. However this drug had a range of distressing side effects, one of which Edward had was the shuffling gait known to nurses as the ‘chlorpromazine shuffle.’

He would also complain of constipation and impotence. He was prescribed a regular dose laxatives and he often requested Viagra but would talk about not being able to get rid of his erection for hours. You had to laugh with him, his tales were hilarious. He told me about one time when he was on the bus returning to the unit and the movement gave him an erection just as his stop was coming up. It was summer and he was wearing just shorts and a t-shirt so he had no way of covering the erection. He had to stay on the bus and went miles out his way.

My main task with Edward was to get him to take better care of his hygiene. He was physically fit and more than able but he really needed a ‘kick up the backside with my tiny size three’s’, I’d tell him. He also picked his nose and would later want to shake my hand. This was one habit that would have to go and I told him I would never shake his hand unless he hadn’t washed it. I also said I wouldn’t accompany him in the community if he was wearing his usual attire of stained tracksuit bottoms and a dirty old t-shirt. I often used my sons as examples, telling Edward that I wouldn’t go out with them if they weren’t clean.

One afternoon I arrived on the unit and there was Edward, spick and span. He was clean and reeking of cheap aftershave. His receding hair had been carefully dampened down and he wearing mismatched clothes but they were spotless. He’d been waiting for me since after lunch. How could I not take him out to the local snooker hall? This was his favourite outing as the voices he heard were much quieter and encouraging when he was concentrating. It became a weekly treat while I was there but I later saw him shuffling along the street, head down and miserable.

I don’t know why the nurses on the rehab unit ignored any improvement or the hard work that was done. They scoffed at his updated care plans, saying – it won’t last! Why did they think it was okay to let patients revert to their old habits.

Conclusion—Rehab does work — but only if the staff do!

*The Purpose of the Written Care Plan is to ensure continuity of care. The care plan is a means of communicating and organizing the actions of a constantly changing nursing staff. As the patient’s needs are attended to, the updated plan is passed on to the nursing staff at shift change and during ward rounds. http://www.rncentral.com/nursing-library/careplans