From Silence to Strength: Relooking Men’s Mental Health in Bereavement

Preface

Mr. Ram was 17 years old and far away from home in boarding school when he lost his father to a chronic illness. He was aware that his father was unwell but was not informed by his family about the rapidly declining condition. Ram was not informed about his father’s death for almost two months because the family knew he had important examinations to take in the upcoming months. When he was eventually told about his father’s passing, he was in shock, was angry at the family for keeping him in the dark, and felt they made decisions on his behalf, leaving him feeling lonely and abandoned in his grief. His mother and elders in the family told him, “Don’t cry like this; you are the man in this house, and you have to be strong.” Six years later, he is seen changing multiple jobs and facing rejection, which leaves him struggling to cope and confused about how he should be feeling as a man. Mr. Ram was 17 years old and far away from home in boarding school when he lost his father to a chronic illness. He was aware that his father was unwell but was not informed by his family about the rapidly declining condition. Ram was not informed about his father’s death for almost two months because the family knew he had important examinations to take in the upcoming months. When he was eventually told about his father’s passing, he was in shock, was angry at the family for keeping him in the dark, and felt they made decisions on his behalf, leaving him feeling lonely and abandoned in his grief. His mother and elders in the family told him, “Don’t cry like this; you are the man in this house, and you have to be strong.” Six years later, he is seen changing multiple jobs and facing rejection, which leaves him struggling to cope and confused about how he should be feeling as a man.Cancer burden continues to grow day by day worldwide, with an increased number of newly diagnosed cases and deaths each year.

This story about Ram is about his difficult life experiences and how these experiences have shaped him over the years. Today, Ram is 36 years old and married with two children. When he came in for a session, he narrated how he has coped by reminding himself that life goes on and that it was his responsibility to hold himself accountable for all that took place, which involved his family and career. He feels he should possess strong masculine traits to lead a good life, but he also mentioned that it is just what people around him and society expect. The myriad of unresolved questions and emotions of grief from back then has culminated in him asking, “Is it forever that I have to prove to be masculine enough and mask my feelings and losses as a person just to prove to others I am strong?” This story about Ram is about his difficult life experiences and how these experiences have shaped him over the years. Today, Ram is 36 years old and married with two children. When he came in for a session, he narrated how he has coped by reminding himself that life goes on and that it was his responsibility to hold himself accountable for all that took place, which involved his family and career. He feels he should possess strong masculine traits to lead a good life, but he also mentioned that it is just what people around him and society expect. The myriad of unresolved questions and emotions of grief from back then has culminated in him asking, “Is it forever that I have to prove to be masculine enough and mask my feelings and losses as a person just to prove to others I am strong?” A significant proportion of such individuals at any stage of the disease trajectory suffer social, emotional, and psychological distress due to stigma related to cancer, diagnosis and treatment side-effects, survivorship issues etc. Therefore, psychological distress needs to be assessed on a regular basis to understand the reason and severity of the problem in order to help the individuals.

In the grandeur of life, the cry “Gone but not forgotten” is a voice that speaks to every heart. But for men, facing the complexities of bereavement is a challenge of its own. In a culture that thrives on stoicism, navigating grief is a path less traveled. It is a walk of unspoken struggles and a journey fraught with societal expectations. This blog explores the complexities of men’s mental health in relation to bereavement and explores why it is so important to break the silence and create a healing culture. In the grandeur of life, the cry “Gone but not forgotten” is a voice that speaks to every heart. But for men, facing the complexities of bereavement is a challenge of its own. In a culture that thrives on stoicism, navigating grief is a path less traveled. It is a walk of unspoken struggles and a journey fraught with societal expectations. This blog explores the complexities of men’s mental health in relation to bereavement and explores why it is so important to break the silence and create a healing culture.Distress is an unpleasant experience of a physical, mental, social, or spiritual nature. It can make it difficult for someone to cope with having cancer, its symptoms, treatment, both curative as well as side effects. This  affects their survivorship and hence it impacts the entire family.  Distress affect one across the range of experience. It varies from mild to severe, which includes sadness, fear, and helplessness with intensity.

Our Current Scenario Our current scenarioThe 6th vital sign

Discrimination based on mental health has a detrimental effect on access to mental health care, help-seeking behavior, and the first treatment for people with mental struggles or illnesses, resulting in higher rates of disease and death Discrimination based on mental health has a detrimental effect on access to mental health care, help-seeking behavior, and the first treatment for people with mental struggles or illnesses, resulting in higher rates of disease and deathEveryone with cancer has some level of distress at some point of time. Not only the patient but their caregivers too experience some level of distress during and after the course of illness, Moreover, distress extends along the continuum, ranging from common normal feelings of vulnerability, sadness, and fear to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual issues.

Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings. Grief is a complex emotion, and it can be difficult for many people to express it in a way that is appropriate for them. For many men, grief can be difficult to express because they have been taught to suppress their emotions. This can lead to delayed or unresolved grief. Society including mental health professionals must recognize and respect different ways in which grief can be expressed through providing a safe space to share and process these unique difficult feelings.Vital signs like body temperature, pulse or heart rate, blood pressure, and respiratory rate are four physical vital signs that are routinely measured to best described as a patient’s physical status. Pain is designated as the 5th vital sign as being very common symptom in cancer, and distress being highly prevalent in cancer, is designated as the 6th vital sign.

Masculine Norms Masculine norms Vulnerability to distress

Masculine standards are the social norms and behaviors that men and manhood must adhere to within a cultural context. Failing to adhere to these strict masculine standards can exacerbate depression and anxiety, substance abuse, increased health risks, dating and interpersonal intimacy problems, interpersonal violence issues, stigma around seeking help, and an increase in general psychological distress. Masculine standards are the social norms and behaviors that men and manhood must adhere to within a cultural context. Failing to adhere to these strict masculine standards can exacerbate depression and anxiety, substance abuse, increased health risks, dating and interpersonal intimacy problems, interpersonal violence issues, stigma around seeking help, and an increase in general psychological distress.Forty percent of patients diagnosed with cancer experience significant level of distress.  However fewer than 10% of patients are identified and referred for appropriate psychosocial support. Screening for distress is important for every patient at the appropriate time, and this needs to be managed by health professionals with the required expertise.

While masculine norms seem to be important to society at one end, it is also important to consider that grieving is a natural experience for all man-kind. Men are no exceptions, and hence, they too can equally feel vulnerable to grief through the journey. As suggested by the well-known psychiatrist Elizabeth Kubler Ross, sailing through grief can be a continuous and fluid journey with waves through different phases like denial, anger, bargaining, depression, and acceptance. Being in denial can help one take the shock of the sudden loss initially, but prolonged denial can impact one’s well-being. Anger is a large wave of many emotions, but one barely swims deep to see the other emotions resulting. Bargaining might not change the situation, but the wishful thinking behind it provides coping. Society holds a taboo against depression, but no one steps forward to understand the multiple complex layers and help one resolve issues and pass through it. Acceptance (with unique meanings to each one) comes with time, and patience is what is not understood by all. An important bottleneck is the silence taken by the individual in the shade of masculine norms. While masculine norms seem to be important to society at one end, it is also important to consider that grieving is a natural experience for all man-kind. Men are no exceptions, and hence, they too can equally feel vulnerable to grief through the journey. As suggested by the well-known psychiatrist Elizabeth Kubler Ross, sailing through grief can be a continuous and fluid journey with waves through different phases like denial, anger, bargaining, depression, and acceptance. Being in denial can help one take the shock of the sudden loss initially, but prolonged denial can impact one’s well-being. Anger is a large wave of many emotions, but one barely swims deep to see the other emotions resulting. Bargaining might not change the situation, but the wishful thinking behind it provides coping. Society holds a taboo against depression, but no one steps forward to understand the multiple complex layers and help one resolve issues and pass through it. Acceptance (with unique meanings to each one) comes with time, and patience is what is not understood by all. An important bottleneck is the silence taken by the individual in the shade of masculine norms.This becomes clinically significant when it interferes with the patients’ general functioning with their cancer treatment or with their progress in cancer care. It can be influenced by many factors such as type of cancer, stage of cancer, type of treatment, individual characteristics such as patients’ personality, available social support, financial conditions etc. Psychological distress is common as patient with cancer move beyond their diagnosis and into the intensive treatment. Distress is very common among cancer patients across diagnosis and across the disease trajectory. Psychological distress is common in cancer patients; however, it is often unrecognized and untreated.

Grieving is a universal human experience, but men are often held back by society’s expectation that they should be “strong pillars.” It’s time to break the taboo around men’s mental health when it comes to bereavement. There’s a time and a place for everyone to feel vulnerable, but it’s important to remember that speaking up is the only way to heal. Grieving is a universal human experience, but men are often held back by society’s expectation that they should be “strong pillars.” It’s time to break the taboo around men’s mental health when it comes to bereavement. There’s a time and a place for everyone to feel vulnerable, but it’s important to remember that speaking up is the only way to heal.Patients are vulnerable to distress at various stages of the disease trajectory, since they face the risk of substantial and permanent physical impairment, disability, and inability to perform routine activities. Investigation periods/ process and finding out diagnosis, getting treatment and facing its side effects are the stages when patient’ vulnerability is high. Stressor of the survivorship, as the constant fear of recurrence or relapse is always there.  Getting back to the normalcy also becomes a challenge for many people surviving cancer.

Expressing GriefExpressing GriefVulnerability to distress

The case study mentioned at the beginning is an example of how men, too, experience the intricacies of grief but cannot express their feelings. The first step in the healing process for an individual is to allow them to express their grief openly. Whether through conversation, writing, or creative expression, providing men with ways to express their grief empowers them to navigate the emotional rollercoaster of grief. Expression freedom enables men to express their emotions in a way that allows them to feel more in control as they move through the grieving process. The case study mentioned at the beginning is an example of how men, too, experience the intricacies of grief but cannot express their feelings. The first step in the healing process for an individual is to allow them to express their grief openly. Whether through conversation, writing, or creative expression, providing men with ways to express their grief empowers them to navigate the emotional rollercoaster of grief. Expression freedom enables men to express their emotions in a way that allows them to feel more in control as they move through the grieving process.Patients are vulnerable to distress at various stages of the disease trajectory, since they face the risk of substantial and permanent physical impairment, disability, and inability to perform routine activities. Investigation periods/ process and finding out diagnosis, getting treatment and facing its side effects are the stages when patient’ vulnerability is high. Stressor of the survivorship, as the constant fear of recurrence or relapse is always there.  Getting back to the normalcy also becomes a challenge for many people surviving cancer.

Seeking Support Expressing GriefVulnerability to distressSeeking support Expressing GriefExpressing GriefVulnerability to distress

Grief can be an isolating experience for any individual. Especially for men, who have always been taught to hold themselves strong, maintain their distance and high self-esteem, and deal with grief in silence. This can make it more difficult for men to find someone to lean on.Grief can be an isolating experience for any individual. Especially for men, who have always been taught to hold themselves strong, maintain their distance and high self-esteem, and deal with grief in silence. This can make it more difficult for men to find someone to lean on.Distressed patients tend to make extra visits to the physician and hospitals. Often, they seem to have trouble making decisions about treatment and adhering to the treatment. Patients also become dissatisfied with their physicians and medical care when in distress.

Establishing relationships with friends and family or mental health professionals can be a lifesaver during these challenging times. Support groups, therapy sessions, or even simple conversations can give bereaved men a sense of belonging, reminding them that they don’t have to go through this alone.Grief can be an isolating experience for any individual. Especially for men, who have always been taught to hold themselves strong, maintain their distance and high self-esteem, and deal with grief in silence. This can make it more difficult for men to find someone to lean on.Distressed patients tend to make extra visits to the physician and hospitals. Often, they seem to have trouble making decisions about treatment and adhering to the treatment. Patients also become dissatisfied with their physicians and medical care when in distress.

Coping Strategies

Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.  Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.Early diagnosis and Psycho-oncology services help the patients in theenhancement of treatment satisfaction and helps them cope with the accompanying emotions. It also helps in improving patients – physician communication, respect, and trust. Additionally Psycho oncology services are also helpful in improving patients’ adherence to the treatment regimen and survivorship issues. 

Understanding when professional support is needed is important for mental health care during the grief journey. Psychologists can help navigate the grieving process, provide coping strategies, and provide a safe space for them to express their emotions. It’s important not to stigmatize seeking professional help but to emphasize that it’s a brave step towards healing. The effort to seek professional help might seem like a big step, but the consistent therapeutic process can be nurturing and fulfilling. It is built on stepping stones, but one can not only understand their loss and feelings better but also differentiate between healthy and unhealthy coping. Thus enhancing one’s well-functioning life as an individual.  Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.Early diagnosis and Psycho-oncology services help the patients in theenhancement of treatment satisfaction and helps them cope with the accompanying emotions. It also helps in improving patients – physician communication, respect, and trust. Additionally Psycho oncology services are also helpful in improving patients’ adherence to the treatment regimen and survivorship issues.  Understanding when professional support is needed is important for mental health care during the grief journey. Psychologists can help navigate the grieving process, provide coping strategies, and provide a safe space for them to express their emotions. It’s important not to stigmatize seeking professional help but to emphasize that it’s a brave step towards healing. The effort to seek professional help might seem like a big step, but the consistent therapeutic process can be nurturing and fulfilling. It is built on stepping stones, but one can not only understand their loss and feelings better but also differentiate between healthy and unhealthy coping. Thus enhancing one’s well-functioning life as an individual.Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.  Managing the mental health challenges of bereavement can be made easier by providing men with coping strategies. Mindfulness, self-reflection/ introspection, exercise, and joy-filled activities can help to improve emotional health. Creating a personalized toolkit can help cope with grief with resilience and compassion.Early diagnosis and Psycho-oncology services help the patients in theenhancement of treatment satisfaction and helps them cope with the accompanying emotions. It also helps in improving patients – physician communication, respect, and trust. Additionally Psycho oncology services are also helpful in improving patients’ adherence to the treatment regimen and survivorship issues. 

To summarize, recognizing the unique issues men face in the complex dance of grief is an essential part of building a healing culture. By challenging societal norms, allowing people to express themselves freely, connecting with others, and providing culturally responsive care, we can create a mental health landscape that empowers men to navigate the grief process with strength, resilience, and authenticity. Let’s work together to create a symphony of support where vulnerability is a strength and healing is a shared journey.To summarize, recognizing the unique issues men face in the complex dance of grief is an essential part of building a healing culture. By challenging societal norms, allowing people to express themselves freely, connecting with others, and providing culturally responsive care, we can create a mental health landscape that empowers men to navigate the grief process with strength, resilience, and authenticity. Let’s work together to create a symphony of support where vulnerability is a strength and healing is a shared journey.Psycho oncology is a specialty which is concerned with the understanding and treating the social, psychological, emotional, spiritual, quality of life and other functional aspects of cancer from prevention to palliation and survivorship. Hence it focuses on improving the mental health of individuals who are diagnosed with cancer and their caregivers.   Cancer affects not only to an individual, but it affects the entire family. Hence it becomes imperative to care for the caregivers as well. Patients admitted in the hospital for cancer directed treatment are regularly seen by psycho-oncologist. Therefore, regular screening of distress helps understanding the severity and specific area due to which psychological issues and concerns arise and helps to plan the better intervention for the same.

This blog commemorates Men’s Day, celebrated on 19th November 2023. To summarize, recognizing the unique issues men face in the complex dance of grief is an essential part of building a healing culture. By challenging societal norms, allowing people to express themselves freely, connecting with others, and providing culturally responsive care, we can create a mental health landscape that empowers men to navigate the grief process with strength, resilience, and authenticity. Let’s work together to create a symphony of support where vulnerability is a strength and healing is a shared journey.Psycho oncology is a specialty which is concerned with the understanding and treating the social, psychological, emotional, spiritual, quality of life and other functional aspects of cancer from prevention to palliation and survivorship. Hence it focuses on improving the mental health of individuals who are diagnosed with cancer and their caregivers.   Cancer affects not only to an individual, but it affects the entire family. Hence it becomes imperative to care for the caregivers as well. Patients admitted in the hospital for cancer directed treatment are regularly seen by psycho-oncologist. Therefore, regular screening of distress helps understanding the severity and specific area due to which psychological issues and concerns arise and helps to plan the better intervention for the same.

Author: Keshav Sharma

Psycho oncologist & Lead counselling services
Bagchi Karunashraya Palliative Care Center
Bhubaneswar, Odisha,  India