216: Man Down - Why Depression Hits Different for Men

Scot: How are you doing, Mitch?

Mitch: I'm getting back to it.

Scot: All right. After the wedding?

Mitch: Yeah.

Scot: Okay. How about you, Eric? How are you doing?

Dr. Monson: I'm doing just great today. Staying busy.

Scot: All right. Well, I have a question. When somebody asked you how you're doing . . . And I'm not saying like I just did there. I'm saying, "How are you actually doing?" Maybe they even dig in a little bit and they're like, "Something doesn't quite seem right." Did you tell them the truth in that instance, or did you just say, "Fine," or, "Kind of busy lately," or, "I'm a little tired"?

Mitch, did you actually tell them the truth when somebody dug in on you?

Mitch: Well, yes, more recently. But if you were to go back even five years ago, I would have been the "I'm here" type of guy, and I would have left it at that.

Scot: John, how about you? I mean, usually, when I ask you how you're doing, it's nothing but positives, right? It's double A, A++. Have you ever told the truth when somebody really dug in?

Dr. Smith: Oh, yeah. I mean, my canned response all the time at work is, "Living the dream," because it's true. But, yeah, there are certain individuals where I'm more apt to give them kind of a fuller accounting of the day, so to speak. But yeah, I definitely do. Maybe not as much as I should, but I think definitely something that I do.

Scot: All right. I'm going to admit that . . . I like that you said, John, it depends. There are certain people. And I think that's the way it is for me. There are certain people I might say that to. Other people, even if I was in just really bad shape, I don't think I'd say anything.

You've got to kind of pick and choose who you can say that to, because I've done it where I thought it was going to be okay and you get looks, right? Then it's awkward, and then it's weird, and then it's just like, "Why did I even bring that up? I don't know."

That's what we're going to be talking about today. If you're not doing well, do you actually have a conversation about it? Do you actually tell the truth? Because men are dying literally from not having that conversation. And we've got somebody here who studies exactly why.

This is "Who Cares About Men's Health," where we share information, inspiration, and a different interpretation of men's health. My name is Scot. I bring the BS. The MD to my BS, Dr. John Smith.

Dr. Smith: Hey. Thanks, Scot.

Scot: Our health convert, Producer Mitch.

Mitch: Hey there.

Scot: And we're joined by our expert today, Eric Monson. He's an MD and PhD, a psychiatrist and researcher at Huntsman Mental Health Institute. Welcome, Eric. And I have a question for you. You do this for a living, but do you tell the truth when somebody digs in?

Dr. Monson: That's, I think, such a good question. And I think already the point has been made that it kind of depends on who I'm talking to. And so, yes, I do sometimes, but it just really, I think, depends on context and the people that I'm talking with, how well they know me, how much I trust that situation, those sorts of things. And so it just varies. Yeah.

Scot: Okay. So you're advanced in this probably. Maybe Mitch and you are on the same level, but you're advanced. Have you ever reached out to another guy with the intent that, "I am going to have that conversation with him, because I know he's a trusted source and I just need to talk to somebody"?

Dr. Monson: Yeah, I absolutely have. I would say probably my go-to has typically been important people in my life. My own father would be someone that I would reach out to. But I've had some really good friends in my life, too, that I've been able to reach out to if I needed to really talk about something.

Scot: Yeah. How about you, Mitch? Do you have kind of a go-to?

Mitch: I have a couple of friends that I'll text and be like, "Hey, can you just tell me I'm awesome?" And then they will. Then there are another couple of people that I will be like, "Hey, can we chit chat?" But for a long time, I didn't have those people or feel comfortable I could have those conversations.

Scot: And are you right to the point, just saying, "Hey, I'm not feeling great. I need to talk to somebody"? Or is it always, "Hey, let's get together," and then you kind of have to side-sidle into it?

Mitch: It used to be always a side saddle, but these days, sometimes it's just like, "I am not feeling happy. I'm feeling really anxious. I'm feeling really whatever." And so I've got a couple of people I can do that with.

Scot: How about you, John?

Dr. Smith: I'm really lucky. I live about five minutes away from my sister. And so she's someone that I'll have those conversations with. And then I've got a few good friends that I'll reach out to.

But my sister, we end up getting together. Just the other day, I called her on my way. I was headed to go grab something. I said, "Hey, I'm headed over to . . ." I think I was going to Sam's Club. And I said, "Yeah, I'm going over to Sam's." She goes, "Come pick me up." So I just scooped her up. And on our way there, it just happened that we both kind of unloaded some things that were kind of bothering us with kids or home life or whatever. It was really nice.

Scot: Yeah. I love it. It's the side-by-side talk. Baseball games, car rides, sitting on the bank fishing. That's how we like to have our conversations.

Well, it sounds like, for the most part, we here do those things, but I know a lot of guys that don't for whatever reason. And this is a little shocking because a lot of men really do struggle with this, and they avoid doing the thing that might actually help.

Check this out, guys. Women are diagnosed with depression at higher rates than men, but men die by suicide at nearly 4x the rate.

Mitch: Wow.

Scot: So there's something inherently going on here that's different. Women have more depression, they're diagnosed with it at least at higher rates, but yet men suicide 4x the rate. Why is that, Eric?

Dr. Monson: There are a lot of different reasons that get involved here, but I think one of them you've already touched on. And that is that a lot of men don't necessarily feel like they've got somebody that they can talk to openly, that they feel completely safe with.

That's really what a lot of this comes down to, is a sense of safety, a willingness to be vulnerable. That's something that, at least culturally, has not been allowed for men, really, until quite recently. And even now, there are a lot of folks that don't feel that they can comfortably do that. And so I think part of it is culture and stigma around mental health.

I think part of it also is that really . . . I bring up this example a lot, but if we think back to how we've dealt with other health conditions that differ between men and women, the example that I like to bring up is heart attacks, right? So heart attacks are something where we have this very . . . We have this kind of picture ingrained in our minds of what a heart attack looks like, what it feels like. We think about the pain in the arm, the jaw, the pressure, the crushing, the sensation, all of these things, someone clutching their chest.

Scot: Right. Or the stereotypical "Saturday Night Live" Superfan sketch where they're hitting their heart or . . .

Dr. Monson: Right.

Scot: I think it was Red Fox that was like, "Oh." He grabs his heart. "I'm coming for you, Martha," or whatever her name was.

Dr. Monson: That's totally right. And so this is the way it's been conveyed for a long time. And because of that, there were a lot of women who died from heart attacks because it turns out women tend to have different symptoms. They might just honestly feel some indigestion. They might just not feel well. They won't necessarily have the same constellation of pain.

We have come to appreciate that now, and our clinicians know better, and we're starting to educate the public a little better so that they're aware. But we still have yet to do this, I feel like, in a systematic way for men and mental health. Just recognizing that the way that men may express when they're not feeling well from a mental perspective is different than what it is for women.

And a lot of our mental health conditions have been primarily described in women for a lot of reasons. I think one of them is primarily because women actually pay attention to when they're not feeling well, and they tell others about it. That's kind of a more natural thing for them.

Scot: So that's fascinating because so much of medicine is . . . the studies have been done on men. But you're saying depression tends to be more woman-focused.

Dr. Monson: Yeah.

Scot: I'd imagine there is probably . . . in the history of medicine, it's like, "Well, men don't get depression. This is a female concern." Is that why?

Dr. Monson: I mean, I think that's certainly part of it. I certainly think there are plenty of men who would like to give the impression that they don't get something like depression or anxiety. And I think they will often describe it as something different.

And so if a doctor asks a man, "Hey, are you feeling depressed? Are you feeling anxious?" "No, of course not. No, I'm not feeling those things." They may well be feeling a lot of things, but they don't use those words to describe them, and so it ends up getting lost.

Scot: Is it kind of twofold? There might be more women diagnosed with depression, but it's just we're not catching the men?

Dr. Monson: So I think that's absolutely part of it. It could well be that there are truly more women that have these conditions, but every time there's a major difference in diagnostic rate, I think we always have to consider the fact that we could be missing cases. And I do think that's the case, at least to some extent with mental health conditions. Yeah.

Scot: And then the other thing is, just like you said, the heart attack example. Men just have the symptoms differently. Talk about what those symptoms actually look like in men, then.

Dr. Monson: Yeah, for sure. And so there are a lot of different things that a man might show if he is feeling unwell from a mental health perspective. And so some of the more common ways that men might show that could be similar to what a woman might be feeling, although they may describe them differently. But those could be things like they are feeling a bit more down, less motivated, less interested in things that they typically enjoy.

But there are also a lot of things that men tend to do more frequently, and those include doing things like replacing the negative feelings that they're having with some other activity. This happens a lot with men who are already people who do a lot of work. And so they might be someone who, for instance, leans into their work a little bit more.

And so now they're home a little less often. They're doing a lot of work. And this is challenging because society often actually really applauds this. It's like, "Nice job." You're working so hard that, in fact, it could be kind of an avoidance strategy that's going on. So that can happen.

Men are much more likely to abuse substances. Again, I think it's another part of this "I need to get out of how I'm feeling right now. And this is a quick way to do that."

They are more likely to present as irritable and kind of more outwardly aggressive. And so a lot of times when we think about depression in women, it's kind of more inwardly focused, more of those described suicidal thoughts or self-harm thoughts, things like that. In men, it may be more likely that they are going to be irritable and aggressive with someone else.

I think one of the big challenges we tend to have with these types of symptoms . . . So if you think about substance use and aggression, things like that, they have a tendency to get men into trouble as well.

And so wherein, if a woman is saying, "Hey, I'm not feeling well. I'm feeling really negative about myself," that may induce others to reach out to help. In a man, if he's becoming aggressive, using substances more, he may actually get in trouble legally and we end up in a much harder situation.

Mitch: That's actually taking me back to my college days, had a lot of underdiagnosed stuff going on. But what used to be really funny stories has now . . . with a look back, it's like, "Oh, man, I was depressed."

It was everything from extreme risk-taking, being really angry and irritable. If a friend was saying, "Hey, are you feeling down?" I'm like, "No, let's go get more drinks." And then you have a crazy evening you can't remember, and it doesn't really help.

But at the time, it was just like, "Oh, Mitch is just fun. Mitch is just a guy. Mitch is just a crazy person." And I really think I was probably struggling with depression.

Scot: Wow. Again, that's rewarded for young men to be the fun life of the party. So it's just kind of this loop that just keeps reinforcing itself.

Hey, John, question for you. How do you experience symptoms of depression? Did any of this ring true? Have you gone through depression and maybe didn't know it? Do you have something you could share?

Dr. Smith: I'm probably too dumb to be depressed.

Scot: I wish you'd stop saying that, but okay.

Dr. Smith: No, I've struggled with emotions probably for most of my life. Just putting a lot of things . . . and I've tried to unpack this. Not to make this about me, but you did ask me how I feel about it. But I've had difficulty with that, where I feel like I have somewhat blunted emotions just from some childhood things that happened with my parents getting divorced, and then things that happened. I kind of shelved a lot of that.

And a lot of the things that we look at as being a guy or whatever . . . like, I put more effort into sports, and I just kind of used that rambunctiousness and that rowdiness to probably cope with that as a kid.

And so I was actually thinking, as Eric and Mitch were talking of those things, to help me unpack this further, which was kind of selfish, but also curious. Eric, have you found words or phrases that can kind of help men realize the things that they're feeling and doing?

Mitch's experience and my experience do seem to kind of dictate that women kind of feel that down and whatever, and men may say, "Oh, well, when I feel anxiety or depression, it makes me motivated to go and try to do more or XYZ."

Have you found those things to be true? Or are there any insights you can give on ways where a guy who's out there who might be like Mitch or myself, where we kind of have a hard time putting our finger on it?

Dr. Monson: Yeah, absolutely. First of all, I just want to comment on a couple of things that I think have come out of the stories that, John, you and Mitch have shared as you've been talking through this. And that is a lot of this kind of retrospective awareness, right?

At the time, it's not what you're thinking about, but when you look back, it's like, "I really see that now. That was something."

And what I really want to look at and what I encourage people to notice . . . This could be the man themselves who may notice this, but it could be others in their life as well. It's almost like this kind of pressure that comes into play where it's almost as if it's out of their control. It's like, "No, I need to go to this party," or, "No, I need to get back to work. I've got to do this thing." And there's just kind of this pressure that's there that you have to be doing this thing.

A lot of people retrospectively would notice that. In the moment, I'm not sure that they would necessarily recognize immediately that that's taking place, but others around them may notice that and say, "Hey, this is not like you. This is not how you usually spend your time. You've been at work all the time lately. Is something up?"

If there is someone who's kind of spending a moment and they're just looking at themselves and thinking about what the pressures are that are driving them to do the things that they're doing, if they can sit and think about that and it's not entirely clear why they've been spending so much time at work or why they've been drinking more alcohol lately, and if there's anything that just seems out of place or confusing about that, that could be a sign that something's not going right there.

Scot: So is there a fine line between depression and burnout? Unlike Mitch and John, I think I am the opposite. I lose all sorts of motivation. And I think that's more the classic sign, right, that you always get asked by the doctor? I lose motivation. It's like I'm physically and mentally moving around with concrete boots on sometimes.

Dr. Monson: Absolutely. And I think that this is sort of the interesting piece about psychiatric illness, in general. There's still a lot we don't understand about how they happen, but I think that there's kind of a continuum that exists between different types of symptoms, whether it be anxiety, depression, symptoms of burnout.

I think this is all part of the same spectrum of stuff. And if something goes on long enough without being corrected, it can move from one space into another.

So burnout might be this thing where somebody's been working really hard, and they're just really tired. And if they took a couple of days and just kind of recouped, they might be feeling better.

But let's say you take that person and you put them in that burnout situation for several weeks, even a month or more. There's a point where you begin to say, "This isn't just burnout anymore. Now we're moving into the space of what we call a clinical major depressive episode." There's really something more that's going on, and it sticks as well. Taking a day or two off, it's just not feeling better.

I think that really is something that takes place over time, especially with chronic stress exposure. We all kind of succumb to this eventually. I think different people have different limits, but I think we would all end up there eventually if we stay in that burned-out space too long.

Scot: Symptoms aside, because it sounds like they could vary a lot, is there something you tell men when you're trying to get to whether they're depressed or not, you're trying to make a breakthrough maybe because they're in denial or they don't realize it, that sometimes makes it click for people?

So, for example, on this podcast before, we had a mental health professional say, "You know what? It just shouldn't be this hard. If life is hard for you emotionally and mentally, it doesn't need to be that way. And that might be a pretty good sign that you can go and seek out help and have it be better."

Dr. Monson: I think that's a really good question. And I think it varies because, again, different people are coming from different places. They have different perspectives on why they're feeling the way that they are. Everyone usually has an explanation for why they're feeling the way that they do.

One of the things that I think is usually helpful for people is, again, as we've been talking about, kind of this retrospective view, right? Looking back and seeing something that was different.

I think the same can be said for when you're not feeling great, but you know you haven't always been this way. And again, the point being that you could feel a lot of different things, and that's going to vary from person to person.

But one of the things I often ask people is, "Has it always been like this? Was there a time when you feel like, as you look back in your mind, you remember that it just wasn't like this, that you felt better a while ago? How long ago was that? And what was it like? What was different compared to now?" I think that's where the differences come in.

Another way that I sometimes think about it with people is . . . I talk to people about the idea that there's this baseline mood where we live. And if you imagine that there's this place that we return to when we're not really happy, we're not really sad. It's just this place that we live.

Let's say something exciting happens. We're going to bump up. We're going to be higher than that. Something really sad, depressing, or anxiety-provoking happens, it knocks us down. But there's always this place that we return to.

And I will just ask people, "Do you feel like that place has shifted at all for you, that place that you come back to?" And the way that you might notice it is now maybe if it's gone up, maybe all the good things are over the top and they're just crazy. Or if it's gone down, maybe good things are not quite as great, but bad things are really bad, and you just feel much worse than you remember.

And then just try to get them to think about, again, "When did that shift happen? How has this occurred for them?"

I think those are some of the ways that I really try to look at it. It's kind of that retrospective view. I think we can see a lot better in the past than we can where we're at, at this moment.

Scot: Hey, Mitch, what's your baseline, do you think, on a scale of 1 to 100?

Mitch: Oh my god. I've just found it these days. It's been in the last couple of years, I've kind of found it.

Scot: What is it, 1 to 100?

Mitch: One to 100? Like a 60. I've got some frenetic energy, but I'm not totally down.

Scot: All right. John, how about you? What do you think your baseline is?

Dr. Smith: I mean, I tend to stay pretty high on the baseline. And again, it's situational, right? I think I've said this on the podcast before. I tell myself that I'm not allowed to have a bad day at work because nobody cares what's going on in my life. They have problems they're coming to take care of in my office. And so my baseline at work is probably 95.

And I don't say that like, "Oh, I'm super cool," but I feel like I owe that to my patients. I've got to come and be the guy that's there to help them, not be the guy that comes in and goes, "Hey, man, my teenager is in rehab right now and life's pretty rough. But tell me what's going on with you."

Scot: How about on your day-to-day then?

Dr. Smith: Yeah, at home, I would say I probably live somewhere 75. I think I try to keep it positive, especially for the kids, too. If I come home and I have kind of that downer day, that totally is very transparent in how the household mood goes. I tend to try to keep it high. I don't know, maybe I'm going to burn it out at some point, but I feel like a lot of that is due to the surroundings of where I'm at in my stage of life, so to speak.

Scot: This is going to get dark really quick. I feel like my baseline is like a 20. I feel like my whole life, my baseline has just kind of been low. I come from a family of depressive people.

And I actually want to talk about . . . Eric, did you hear anything in those stories, Mitch, John, or myself, that concerns you or that's good? To hear "always be at a 75 for my family" sounds exhausting, quite frankly.

Dr. Monson: I'll be honest, that is what I was thinking a little bit. And we're not here to judge, right? We're just talking through this stuff.

Scot: But on the other hand, maybe the family is what gives you that energy, right? So maybe it's not exhausting. Maybe it's energy giving.

Dr. Monson: And that's what I was going to say next, really, is that we ourselves may hear something like that and we imagine, "Well, this sounds like this tremendous effort to keep that up." And if the answer is, "Well, it is a tremendous effort. This exhausts me to be this way," then that probably isn't good.

But if it's kind of where you live, and you feel like because of the feedback and the motivation that you get out of the space that you're in that you feel that way, I think that's great. And especially if you've sustained it over time and you're doing just fine, I think that's great.

I do think there are people who live in a "higher mood space." And I think what we really want to look at is more stability over time rather than, "Do you think you're super happy or not?" Because that's a very subjective thing. But the reality is that we all kind of live in a different space, and how well we can sustain that, I think, matters much more than exactly where we describe that space to be.

Scot: And also, this idea of we live in different spaces . . . so I'm thinking in my instance, I'm like, "I've got to up my game." I'm listening to these two guys. But then that's a lot of pressure, right? So my natural space is 20. Maybe that's not a bad thing. That's just where it is and you just have to be accepting that. But it can be very difficult because society might say, "Well, you need to be up more. You need to be happier."

Dr. Monson: I mean, I would really think about it, too, as a matter of perspective, right? If you feel like, "Hey, I don't describe myself up as high as John is saying he is," I think that what you've really got to be thinking about is, "But am I okay where I am? Do I feel okay?"

I think that matters more than exactly where we might put ourselves, because there are people who are just at a higher energy level. They're extroverts and introverts and all of these types of people who get energy from different situations. I don't think any of those are wrong. We just need to be true to ourselves, because I think what is really exhausting is being someone that you're not.

Mitch: Yeah, one of the early things when I was first starting my mental health journey was my professional asked me, "So it sounds like you are taking on a whole bunch of clients, and you're doing a whole bunch of things with friends, and your calendar is completely packed. Are you doing that because you enjoy it? Or are you doing that because you feel you have to or that you have to run away from having a spare moment to even sit with how you're feeling or whatever?"

And that was a really big shift for me to be like, "Am I taking this project just because I really want to or just because I'm running away from some problem in one way or another?"

That's one of the checks that I do. Like you were saying, that little retrospective. It's just that moment to check in. And I know John's talked before about he does a little bit of a check-in every so often. That's one of the best tools I've ever learned.

Dr. Monson: Yeah, I would say that one of the things that we'll hit on again, I feel like, is that the idea of "What is your motivation? Why are you doing what you're doing right now?" And trying to be open and honest about that with yourself, right?

I think that can be really instructive as to whether what you're doing right now is based out of a space of safety and health, or whether it's coming from some other thing that's motivating you possibly to be someone that you're not, and just recognizing that may not be sustainable.

Scot: How much does biology, culture, and stigma play into obscuring or making it difficult for men to figure out if they are actually dealing with depression?

Dr. Monson: I think that it's hard to isolate all of those things. You talk about the whole "What is my environment? What are my genetics? What is all of this?" And I think all of it is an environment that we are created out of, our families, the way that they naturally are.

As you had pointed out, sometimes we may be at a little bit of a lower mood space because that's just kind of where our family is, and that's where we tend to live. And so I think that there's a lot that comes from just the environment around us and the expectations that are placed upon us.

We do know that genetics play a role in this. It's a little bit complex because I think the biggest challenge we face with trying to tease that apart is that we still don't really understand how the brain works. It's a very complicated structure. And we don't really understand how different changes, or adjustments, or stresses that we face really shift what the brain is doing and how it's functioning to create the symptoms that we think of as depression or anxiety.

We know, though, that there are things that are happening there. And so absolutely, the genetics that we inherit from our families will play a role in that. Things like trauma that our family has experienced as well. We know there's intergenerational trauma that appears to be able to be passed from, particularly, mothers to their offspring. So there are a lot of different facets that get involved here.

At some point, we've got to figure out exactly how the brain works and we'll be able to answer this a little bit better. But I would just say that it's almost completely impossible to separate yourself from the family and the environment that you grew up in, and the culture that surrounds that space, and how they collectively view things like mental health. That's really going to inform what you think of as good mental health, bad mental health, all of those types of things.

Not a very satisfying answer in some ways, but it's kind of the reality.

Dr. Smith: These are the things in this podcast I think are good, though. We don't always need the answers as guys. And I think we've talked about this before, of having the tools to be able to figure this out, having the understanding that we don't know everything about the brain.

I mean, the neurology stuff that we know is limited. But I think understanding some of those other things that we do understand now, that, "Hey, sometimes there is some family trauma that can be passed down."

Scot and I talked about that a little while ago, about some of the studies that have been done in mice, and then they recapitulated them in humans. And some of the things that are out there now are fascinating.

I think just having the tools at our disposal and understanding the landscape of what this looks like for guys, to me, is where we want to obviously make sure we do a good job in our podcast to share that with people and say, "Hey, we don't need to have all the answers, but we need to know that we can help each other out."

What are your thoughts, Scot? Didn't mean to cut you off.

Scot: No, no, no. What I was going to say is, how can we use biology, culture, and stigma in a positive way as we try to unravel, "Am I actually dealing with something?"

I'm going to share. So I come from a ranch background. I was an only child, very stoic parents. We never really talked about anything of significance or import. There probably was never a time I ever said anything like, "I'm stressed," or, "I'm depressed," because we didn't get those things. That's not something that I suffered from. And I'm sure I learned that from my culture. There might be some biology there. There could be some stigma there as well.

And it took a long time for me to kind of even admit and realize that, "Actually, you know what? This thing I'm feeling right now before I go do this thing, I guess that's anxiety. I guess I do get anxious," or, "This thing I'm feeling right now, that actually might be depression."

I've had all these other things in my life that have kind of obscured me from realizing that because of whatever stories I told myself.

Mitch, do you have any examples that could maybe help a man listening better understand how biology, culture, or stigma might get in the way of them trying to figure out what they're dealing with?

Mitch: Me? Wait, what?

Scot: I don't know.

Mitch: I mean, I can give some personal experience.

Scot: Yeah, that's what I mean.

Mitch: Yeah. So, for me, the biggest shift in my mental health after years and years of just plain old talk therapy and a little bit of EMDR was getting diagnosed with ADHD. There was something biologically different in my brain that was making it more difficult to connect with my emotions, sit with my emotions, etc.

And I can just tell you that once I kind of got that figured out, once I found a doctor who was able to treat and work with me and give me some training and behavioral training, etc., other things started to calm down, right?

I was initially diagnosed with a severe anxiety disorder, and then that's pretty much gone these days because it was really related to the literal wiring and chemistry in my brain. And I know that that's genetic.

Scot: Yeah, that's the biology part.

Mitch: I know that the family is connected to that, too. And so I don't know.

Scot: I think that's a great example. Eric, do you agree? Is that a great example?

Dr. Monson: Yeah, I do agree. I was actually going to offer another example too, something that I've seen a lot of times that I think incorporates all of these pieces.

Again, I think it's this . . . One thing you just mentioned there, Mitch, that I think is really important is this moment when you begin to recognize, "There is something going on here. Maybe there actually is an explanation, and maybe there are actually ways to have it different than it actually is right now."

And one of the things I work with a lot in my clinic . . . I'm a child and adolescent psychiatrist, so I have a lot of kids who come into my clinic. And I'll notice as I'm working with them that there are some features there that make me think, "I wonder if this kid actually has a little bit of autism spectrum features or maybe even a diagnosis of that." And there's definitely biology involved with autism. It's a neurodevelopmental condition.

But when you have somebody who has these types of symptoms, one of the things that is often the case is that their families also have that because there's this biological loading for autistic tendencies that is typically passed down from parents. And so the parents will be watching their child grow up, and they'll say, "Well, no, this kid is completely normal. He's just like us."

And so, yeah, what you're experiencing is completely normal. "No, I couldn't get along with anybody in middle school either. No, I didn't understand any of those jokes either, but that's just normal. That's how it is. That's our family." I think that shows how that interplay of the environment and what that environment tells you about what you're experiencing, mixed in with the biology that you're getting from others that share your environment with you, can make the picture pretty cloudy.

It can be hard, especially if the message is, "This is completely normal. There's nothing different or wrong with you," so to speak.

Scot: Hey, John, how about you? Biology, culture, and stigma, have there been any of those things that you've had to work through to recognize . . . Because you talked earlier in your life, you kind of pushed it down, which is a very manly thing to do, by the way. That's what we do with our emotions, right? We push them down. We go to the gym, and we work them out. But have you run into any of those things that you had any revelations where you're like, "Oh, okay. Now I'm starting to understand better"?

Dr. Smith: Yeah, I think it took me a while to kind of piece those things together. I mentioned earlier my parents got divorced when I was really young, and there were some things that happened growing up. My dad wasn't in the picture, but he would come back around, and I know I had some resentment things there. And I've had to work through some of that.

There was some stigma growing up in Utah with divorced parents, things like that that I worked through. Just having good people around me that really helped me through. I was in the Boy Scouts as a kid. I had some really good folks help me out there and really help me to grow and start to believe in myself and do some of those things.

As people say, kids can be in the same environment, and one can go one way, and one can go the other way. Case in point, the one becomes a drug dealer, the other one becomes a cop. I think there are like 50 movies about that, right? The brothers that grew up together.

And so I think, "What was the transition period for those folks?" I don't know what it is. Just like some of these things that are not super satisfying answers, but I don't know that I have any revelations other than recognizing it and then having the discussion about it.

I think those are the big things for me. Having discussions with my siblings about things that happened growing up, having conversations with my mom before she passed about those same things. All those things, I think, are really where I've found most of the growth for myself, is kind of facing up to some of those things that I felt were challenging and allowing myself to kind of conquer them, so to speak.

I don't know if that's dumb or not, Eric. I'd love to hear your opinion on that, but that's how I've pushed through.

Scot: What I'm hearing from John is he might have had some of what you said, family trauma, right? And it sounds like there was a point where it could have gone one way or the other. Luckily, he's a doctor and not a drug dealer, so I guess it went the right way.

Dr. Monson: What I really think tends to happen for a lot of people is something similar to what John is describing here, where we will have some thoughts or maybe some moments where we pause, and we're like, "Is everything that's happening to me completely normal? Am I doing okay?"

I mean, people I think will often pause for a moment and think about those things, but it's especially when you get around other people who are maybe not part of your immediate family or biological or cultural circle, especially when people go out and they meet a partner that is willing to really sit and talk with them in detail, or a really good friend, and they can just ask that question.

Or as you pointed out, you grow up with your sibling and then one day you guys sit down together, and you're like, "Was it just me? Was there something off about all of that? Are we doing okay?"

I think it's those conversations that really tend to be the moments of insight for a lot of us when we have that person who's just . . . Either they have grown past it with us or they were not there back then, but now they can kind of help us evaluate it, and we can kind of see how things went through.

And to the other point, I really do think our environments and the people around us and how supportive they are do play a big part as well in how we turn out, right? Are we going to be the doctor or the drug dealer?

I think that has a lot to do with the people that we surround ourselves with and the ways that they work with us to motivate us, and whether they challenge some of the things that we do or that we say, or whether they just kind of go along with it.

And I think that's really important to recognize, "The people who are around me, how do they push me? And what direction do I tend to go in when I'm around them? What kind of person am I?" I think that, again, is another one of those kind of environmental factors that really plays a big role in where we go.

Scot: All right. So if you're listening and you're starting to get some clues here that, "Well, maybe that's me" . . . Maybe you're grinding more than you used to, you're staying at work longer. Maybe you're numb. Maybe you're doing things to try to avoid it, whether that's drinking or whether that's engaging in other distractive behaviors.

By the way, mine was buying stuff I didn't need on Amazon and eBay. That was how I distracted myself. So it can come in all different shapes and forms.

Changes in sleep, exercise, socializing. If you're starting to get some clues, maybe a genetic predisposition to it that makes you go, "Huh, maybe I am actually experiencing depression right now," what helps?

And I want to get specific here. So one of the things I want to ask you about is the I Love You, Bro Project, which is iloveyoubroproject.org. What is it, and why does it seem to work for men?

Dr. Monson: So, really, the I Love You, Bro Project is a support group structure. That's what it's built around, is the idea that there are people that gather together who are there to support each other.

Immediately when I say that, I think a lot of men will be nervous about the idea, right? But I think what's different about I Love You, Bro is that it is composed of regular guys. They're coming together with the recognition that none of us are perfect, that sometimes it just helps to have someone to talk to. It helps to surround ourselves with other people who are trying to feel better, do better.

The whole premise of the program is really that they do everything they possibly can to make it a space where you feel like you can really talk openly about what's going on for you. And there's no judgment. You're just there to be around other people.

And to be fair, this is something that I think women have done far more naturally and are much better at than men for a long time.

I think one of the biggest challenges, frankly, with a program like I Love You, Bro is just getting guys to go there in the first place. I mean, that's really the core of it, though, is that they're there to support each other and just talk together.

Scot: Now, I've never been to group before like that, but I can tell you what having conversations about this stuff does. And if you don't have somebody in your life that you're able to have these conversations with, or even if you are . . . I mean, some people in our life we don't want to have these deeper conversations with. We're too scared. As men, we don't want to appear weak to our wives or our other friends, right? So sometimes strangers are really the best way.

But when you talk about things and when you hear other stories and when other people hear your stories and they respond to them, that's when you start to be able to uncover clues.

An example I'm going to give you actually is a woman that I knew that was talking to some friends. This was before she decided to get divorced, and she was really struggling with it. And she was telling her friends just normally, "This is what my husband did, blah, blah, blah." It didn't seem strange to her at all. It wasn't any way out of the ordinary.

As she's telling the story, her friends' jaws were on the floor. They're like, "He what?" And it was that "if you're in a fish in water, you don't know that you're in water until you get that external reaction to it." And I think that could be one of the big powers of something like getting together with other men and telling your stories and talking about them.

In addition to what we do on this show. I talk about something, and that makes John think about something. And then that makes Mitch think about something, and we start to peel away the mystery.

Dr. Monson: I think the true power behind I Love You, Bro and any other program where there is gathering of people is that . . . One of the things that we know is most powerful in dealing with significant mental health problems is connection to other people, whatever form that may take.

And people, I don't think, always overtly go out looking for connection or they don't necessarily think that that's what they're necessarily doing. But if you go to any place where other people are, that's largely what we're doing. And as human beings, we need to be connected with other people.

There are few things that we have demonstrated in, for instance, suicide research that appear to have a bigger impact than actually having some sort of sincere connection with another human being . . .

Scot: Really?

Dr. Monson: . . . in preventing risk for suicide. That's a huge deal.

Scot: Wow.

Dr. Monson: And it doesn't even have to be a super deep or long-standing connection. It can be someone who is communicating with a person that they've never met who's a peer support person. It could be someone who is being sent text messages by a provider periodically.

Or it could be people who are willing to go out and just be part of a group, even if they're not there necessarily to share their deep, dark secrets, but they're just there. And maybe they're there to support someone else who needs a little bit of help.

But the benefit is real for everyone because it's that connectedness that really helps us.

Dr. Smith: I concur with that. I think those times where you talk about when someone says, "How are you doing?" and you open up, and you talk about what's actually going on, I think that's been key.

I have a couple of friends where we'll just be lounging around, maybe there's a barbecue, and we're there, and there will be a couple of guys standing around, and one of my buddies, especially, will just kind of step in and say, "Hey, man. How are you?" And he'll stop, and he'll say it again, and go, "And I know what your canned response is. I want to know how you're doing."

And that moment of saying it a second time, I don't know what it is, but it allows for a little bit more open, honest conversation of, "Hey, dude. I know you're doing great because we're obviously at your house having a barbecue," or whatever. You know what I mean? He obviously gets that. But he's genuinely inquiring.

I think that as friends, as neighbors, as brothers, as whatever, we can make a difference there by . . . You may not go to share your deep, dark secrets, but your sincere question of, "How are you doing?" is the thing that may get someone to open up and help them in that moment, if that makes sense.

Scot: It does. And here's a pro tip. I think that's trust signaling. You're signaling to that other person that they can trust you, right? And it's also signaling to that other person that, "I'm not looking for the canned response. I'm actually caring about you." Don't get weird about it then. If they get deep, don't all of a sudden get all nervous and awkward, right? Because that's probably not good.

Dr. Smith: I think, to me, when I've asked those questions and talked to my friends, I genuinely . . . there's something that makes me want to know. And I think that's something that we can go and say, but I don't think we want to just throw it around. But I think when we do, it means more when you go in and you say it, and they do feel that you're signaling that trust.

Dr. Monson: Yeah, totally. I was just going to say I feel like what it really is, is an invitation to be genuine with somebody else, to, again, kind of put down any facades that you might be holding up.

Usually, when people are in a situation with other people, they do feel compelled to kind of put on a show a little bit, to make sure that they're okay, that they're being the right sort of person with those people. But I think that's what it really does. "Hey, you can be open with me. You can be real."

Mitch: What if a guy doesn't have those people? I know we talked a little bit about I Love You, Bro, but if they're in a dark place, if they're maybe even considering suicide, where should a person be going to get that person who can maybe help talk them through it?

Dr. Monson: There are really a lot of ways you can get that. If you feel comfortable going to a program like I Love You, Bro, which I hope you do because it is such a fantastic and really just a genuine place to be, then please do that. But also know that there are different resources that are available to anyone.

So one of them is you can just call 988. A lot of people, I think, get really nervous about that idea because they think, "Well, if I call 988, that's like 911. They're going to send a squad car out. They're going to lock me up. Something's going to happen." That's not usually the way those calls go.

And I'm not going to pretend that if you call 988 and you say, "Hey, I'm suicidal. I'm not going to be safe," they may very well send someone out to check on you and make sure that you're okay.

But if you just need someone to talk to, they can help you with that there, too. And they can just kind of work through, "Well, what's going on?" and just kind of talk about what's up with a mental health professional that's just there to help.

They're there just to listen. They don't have any skin in the game of whatever's going on in your life. They can just be there and hear what's up, and that can help a great deal.

There's also the Utah Warm Line, which is a service that's provided typically by peer support folks. It's not available 24/7, but you can call into that line, and they also will just talk about anything. If you want to talk about something that's stressful or if you even just want to share something good, a success, and you just want to connect with somebody, you can do that.

There's also the SafeUT app that is now increasingly available. It used to just be for kind of school-age kids, but we're making it available really to just about any demographic at this point. And you can text on there. You can call somebody and talk to them.

Essentially, of these opportunities, if you don't feel like you have anyone else that you can talk to, these are things that you can do.

And if you're not sure about going and talking to someone or if you just don't actually feel safe at that moment, if you are feeling suicidal, it's okay to go to an emergency room as well. You can talk to somebody there, and they'll help you out. They'll figure out what's up, help you make decisions at that moment about what the next steps are, whether you need to have some additional care or just need some time to kind of decompress and talk to somebody.

And so, yeah, there are a lot of different ways that people can do that.

Scot: Was this helpful, guys? John, was this helpful?

Dr. Smith: I always think these are helpful. I love these conversations where we get to pull the curtain back a little bit and say, "How are you doing?" and really kind of dig into it's okay to not be okay sometimes.

And I want to add one more percentage. My in-the-car percentage is probably 40%. Scot, how about that? Because that's when I call my brother or my sister, and I have those conversations where those things really . . . I let them go. Does that make sense?

Scot: Yeah.

Dr. Smith: So I didn't want to make it sound like it's just all sunbeams and lollipops, or whatever the song says. But I think that there are those moments where we get to let our guard down. And I love these conversations.

Scot: Mitch, how about you? Is this good for you?

Mitch: I think so. Are we doing takeaways? I have a takeaway.

Scot: Yeah, sure. What's your takeaway?

Mitch: Perfect. All right. So the takeaway that I've done as I'm hearing you guys is sometimes . . . And anyone, just come in and tell me if I'm being way off base. But for me, being on this show for a while, I've started to think of mental health concerns like a weird rattle in your engine. I don't know if anyone else has driven just crap boxes for most of their life, where there's that kind of ticka, ticka, ticka. It's irritating, and maybe it's making your life not so great, but you could probably fix it on your own, but maybe you didn't have time.

Talking to other people about what's up with your car can sometimes give you some perspective and help you out. And sometimes you just need to take some time and really kind of troubleshoot and really try to figure out, "What is causing this thing and how do I feel about it, etc.?" And if it gets bad enough, you take it to a mechanic. Otherwise, the car is going to break down.

I don't know. For me, just hearing everyone kind of share their own experiences and some of the things about how men experience depression differently, it's like, "Well, maybe I can do a guy metaphor and help some people kind of maybe think about their mental health a little differently."

Scot: Yeah. I'm going to expand on that metaphor. Sometimes that ticka, ticka, ticka, you can drive for another six years. Sometimes it's next week. Sometimes you don't want to gamble with those things either.

Eric, any takeaways, any thoughts? A lot of times, this particular podcast, it's not about tips and tricks. It's about exchanging perspectives. And sometimes out of those come new perspectives. Did you take away anything today from this conversation?

Dr. Monson: I just think that it really stands out to me, especially in our conversation today, what you guys are saying. A lot of times, unfortunately, it's in retrospect that we notice that something was up.

But I think there's also a lot of real value in really hearing out, when there are other people who are important to you in your life, if they notice that something just seems different or something is going on. I think a lot of us might just automatically kind of say, "Oh, no, I'm fine." But if someone really does pause and say, "No, really, are you doing okay?" I think that in and of itself should be a moment to take, and just pause, and just assess.

Scot: Even if you're not ready to talk about it right then.

Dr. Monson: Oh, yeah.

Scot: If somebody's brought that up, then they've noticed something. So maybe a little introspection is necessary. I love it.

If you have any thoughts or a story about today's episode, any notes you'd like to compare or add, or if something we talked about hit kind of close to home, we'd love to hear from you. You can email us at hello@thescoperadio.com. Thanks for listening and thanks for caring about men's health.