Besides being a freelance journalist, I work as a clinical psychologist at a hospital. One day, M, a 52 year old man, came to the practice on the insistence of his wife. According to her, M had complained of chronic back pain for five years. He’d been traveling on his bike for the last 15 years back and forth to his lowly paid, clerical position. M reported that he had consulted several doctors for his chronic pain but all of them had suggested that he consult a psychologist.
Reluctant to acknowledge his mental health struggles, he had been putting this off—until his condition got worse. After a few more sessions, M opened up and shared that despite being the most senior employee age-wise, he was the lowest paid. His supervisor was the same age as his eldest son. His stunted professional growth was increasingly becoming a source of embarrassment and depression. He shared that he felt like he had failed his family by not providing for them to the best of his ability.
His wife reported that he was becoming increasingly indecisive, had low self-worth and was losing confidence in himself. All these defeatist self-beliefs were negatively impacting his physical and mental well-being. His treatment, which combined both therapy and psychiatric medications, finally led to improvement in his back pain.
M isn’t alone in experiencing financial trauma. Global economic activity is experiencing a broad-based, graver than expected slowdown, with inflation higher than seen in several decades, according to World Economic Outlook. The cost-of-living crisis, tightening financial conditions in most regions, Russia’s invasion of Ukraine, and the lingering COVID-19 pandemic are contributing to this slump. Global inflation is forecast to rise from 4.7 percent last year to a staggering 8.8 percent in 2022.
“A series of harsh events and unprecedented macroeconomic policies are combining to throw development into crisis,” World Bank President David Malpass said in a speech at Stanford University earlier this month. “The human consequence of these overlapping crises is catastrophic.” What are these human consequences?
Economic crises destabilize public service budgets and affect education and health care systems. Lack of job security, poverty, rising debts, housing payment problems and inflation are major socioeconomic risk factors that have direct effects on mental health. Extensive research has revealed that people who experience unemployment, increasing income inequality, impoverishment and family disruptions due to financial issues are at a significantly greater risk of mental health problems, such as depression, substance use and suicidal tendencies—and the effects present disproportionately in men.
In 2020, a groundbreaking study found a link between financial stress and Post-Traumatic Stress Disorder, discovering that the symptoms of PTSD were indistinguishable from those of financial stress. Dr Galen Buckwalter, a research psychologist and expert on financial trauma, characterizes this as Acute Financial Stress (AFS) or Financial Trauma. He described it as a dysfunctional reaction to chronic financial stress and noted that the symptoms often present similarly to those who experience post-traumatic stress disorder (PTSD) from other events.
This condition can hit men particularly hard since in most patriarchal societies, men are expected to do most of the heavy lifting when it comes to providing for their family financially. From a very early age, men are taught to be impervious and invincible which perpetuates the toxicity and stigma that surrounds men’s mental health issues. Since they are often not vocal about their mental health struggles, these can manifest itself in the form of irritability, anger outbursts and violence towards their family. Other men might react by retreating into themselves and isolating themselves at work and home, which puts them at a higher risk for depression, anxiety and personality disorders.
Due to prevailing ideals around masculinity, seeking help can be perceived as a sign of weakness or cowardice. When chronic stress is suppressed for a long time, it weakens the body’s immune system and manifests itself as psychosomatic symptoms—physical complaints with no medical explanation. These symptoms include migraine, chest pain, palpitations, chronic back pain, high blood pressure, digestive issues and changes in sex drive. Mental health issues in men, especially in a collectivist cultures like the Middle East, can have a spillover effect on the well-being of families.
When you are experiencing emotional distress, your body releases hormones such as adrenaline and cortisol. These aren’t necessarily bad—they are “fight or flight” hormones secreted by our bodies when we feel stressed and anxious, and they help us act proactively and protect ourselves from danger. But when excessive amounts of these stress hormones are released, they can cause psychosomatic problems.
Usually people experiencing these symptoms resort to doctor shopping or consulting a variety of experts like an ENT specialist, cardiologist or gastroenterologist. They spend what meager financial resources they have on treating their symptoms without dealing with the root cause that is psychological stress.
Financial trauma is based on an individual’s belief as it relates to money – that it’s scarce, represents power, or that it’s a source of validation or security. These internalized ideologies about money then influence how we spend, save, or manage our money. Financial trauma can show up in behavior such as overspending/compulsive shopping, underspending, workaholism and hoarding. In a way, hoarding is a form of shielding yourself in things, so you don’t feel vulnerable. People with financial trauma may find themselves catastrophizing and having a hard time letting go of things.
According to the World Health Organization, gender differences occur particularly in the rates of common mental disorders – depression, anxiety and somatic complaints, which are reported more in women. On their website, WHO states that gender bias impacts mental health diagnosis. According to a 2020 study conducted in the UAE, 57.2% of participants suffered from at least one mental disorder, with higher prevalence rates in women than in men, except for substance abuse.
However, these statistics do not reveal the complete picture. It is a common belief that in most surveys women appear to score higher on questions related to mental health issues than men. This has more to do with stigma than reality. Since most surveys require the respondents to answer themselves, men tend to score lower since the stereotype associated with men is that they are emotionally strong. Agreeing to mental health issues is seen as a sign of weakness or fragile masculinity on their part, especially in the patriarchal society they live in. Which skews the findings of these kinds of studies.
Doctors are also more likely to diagnose depression in women as compared with men, even when they present with identical symptoms or have similar scores on standardized measures of depression. Gender stereotypes regarding association of emotional problems with women and substance use problems with men also serve as a barrier to the accurate identification and treatment of psychological disorders. Symptoms also differ gender wise. Research shows that depression in women is generally present with prototypical symptoms like crying spells, depressed mood and feelings of worthlessness and guilt while in men, it manifests itself with symptoms of anger such as irritability and heightened aggression, risk-taking and substance abuse.
Dr Farid Talih is an Associate Professor of Clinical Psychiatry at American University of Beirut Medical Center and department vice chair. He sheds light on why men are reluctant to seek mental health help. He claims that historically, and in most cultures including our culture, the societal image of the male is that of the independent, stoic, protector/provider. Being reserved and not displaying extremes of emotion is also an important component of this image. “Therefore, help seeking in general and asking for assistance conflicts with the traditional male image. A simple example is men refusing to ask for directions while driving. This global cultural phenomenon is based on avoiding vulnerability in front of other males,” he explained.
When asked about how he deals with this male reluctance to seek help in his clinical practice, he shared that in general many men are encouraged to seek help by the women in their lives – sisters, mothers, wives. Motivational interviewing techniques help, including acknowledging the strength and bravery required to take steps to address mental health in our culture. Having a non-judgmental, non-confrontational attitude is very important. On the first visit, asking the companion (usually a woman) to leave the interview room is helpful since the presence of others in the examination room may inhibit the man from sharing feelings of vulnerability.
Why is financial trauma more prevalent in men? Talih believes that prevailing cultural norms play a big role. “Men in society have linked provider status to self-image, so lots of energy, mental and physical, is invested in ensuring this status. An integral part of the male self-image is being able to provide for himself and his family. Hence, financial instability can cause psychological instability as well as negatively impacting self-image; since in our society there is a strong correlation between economic success and self-esteem and social status. “
This can then lead to obsessional attitudes with regards to attempts at accumulating wealth. Anxiety and rumination about financial problems can trigger anxiety attacks as well as other unpleasant symptoms such as insomnia or irritability, palpitations, shortness of breath.
Talih added that the phenomenon of over spending or wealth display in our society is directly linked to this issue and can become destructive and unhealthy leading to men falling into a cycle of unsustainable debt or high-risk economic activities which then worsen anxiety and mood in a vicious cycle.
Seismic shifts in cultural values due to social media and the resulting exposure to global content has also impacted how men view mental health in the Middle East. “There are several cultural factors, deep rooted traditions, social norms, traditional importance of family, values and morals that bring on societal standards and expectations on how to “be” and live in the Middle East, both individually and collectively”, he shared.
Other experts agree. Asha Dullabh, a clinical psychologist at the American Center for Psychiatry and Neurology in Abu Dhabi, opines that in the modern world, most of the prevalent cultural factors are being questioned and challenged which in turn can result in distress, bringing up experiences of fear, shame and guilt as new perspectives replace the all-knowing norms that previously existed. It is in this process that individuals turn to compulsive behaviors, such as workaholism, overspending causing stress, burdens, and mental health challenges.
“Patriarchy surely needs to be redefined in the modern world, re-examining the practice in modern times”, she said. “At the same time let’s talk about exalting the concept and role of matriarchy, while accepting that the roles are different, and that certain aspects and responsibilities of home and family life can be shared, with the two systems coexisting, with harmony and mutual respect. A journey from patriarchy to partnership needs to be considered,”Dullabh added.
There seems to be light at the end of the tunnel, according to Dullabh. She shared that in recent years she has seen an uptick in men gradually breaking the stigma of mental illness and disease. They are becoming more comfortable with speaking about their mental health challenges and are beginning to deal with the societal perception of “shame and weakness” and the expectations to “be strong.” She said that in the generation of younger men, mental health awareness has really brought about positive changes in psychological and emotional well-being, and the numbers of men seeking mental health are increasing steadily. Both young and old generations are beginning to question everything. “In my opinion, the new generation of younger men and couples are becoming more open to seeking advice on mental health issues on topics such as finance, gender roles, family responsibility, which will have an impact on couple relationships, family relationships, extending to our communities, our societies, our nation and our world at large.” she reflects. “The internet, including social media, has played a remarkable role and transformed the minds and hearts of men and becoming more knowledgeable and informed about mental illness.”