Wall of silence: Why it’s time to talk about male anxiety
ANXIETY has been with us for millennia.
Ever since man became aware of himself, his surroundings and the concept of the future, he has been anxious.
Up to now, we knew little about the physical effects of the condition but new research is beginning to shed light on the subject and it’s not good news for men.
According to a recent study conducted by researchers at the European College of Neuropsychopharmacology at Cambridge University, men who suffer from anxiety are more than twice as likely to die from cancer than those who do not.
Though complex, the study is worth a closer look.
Using data from 15,938 British participants from a European-wide investigation into cancer, researchers were able to link men and women with general anxiety disorder (GAD) in a period from 1996 to 2000 to death records over the subsequent years and thus were able to identify those GAD sufferers who went on to die of cancer.
They found that 126 out of 7,139 men and 215 out of 8,799 women surveyed had GAD and over a period of 15 years, men with GAD were twice as likely to die of cancer as men who did not have anxiety.
Astonishingly, the same association was not found with women.
“The work shows that anxiety is associated with cancer deaths in men,” says head researcher Olivia Remes.
“We can’t say that one causes the other — it is possible that men with anxiety have lifestyles or other risk factors that increase cancer risk that we did not account for completely. However this association does raise questions, and society may need to consider anxiety as a warning signal for poor health.”
There are many forms of anxiety. Phobias and a whole range of ‘disorders’ from OCD to separation anxiety are classified under the same broad umbrella.
The most common is GAD, which psychologists describe as a more-or-less constant state of worry and anxiety that’s out of proportion to what’s actually happening in an individual’s life.
Symptoms of GAD include increased heart rate, tingling in the hands and feet, hyperventilation, dizziness, feeling sick, tension headaches, hot flushes, shaking and shaky legs.
The anxiety can sometimes become so acute that sufferers think they’re going mad or might die.
Many GAD sufferers report feeling as if things are speeding up and slowing down or that they’re detached from their environment and the people in it.
A diagnosis of GAD is typically confirmed if symptoms are present on most days for a period of six months.
The link between anxiety and fatal illness in men has been examined before.
A Finnish study co-authored by five doctors from two universities in Finland in 2014 followed middle-aged men for 23 years and found that those who scored highly on psychological tests for anxiety had a significantly increased risk of death from a wide range of illnesses, not just cancer.
It is worth noting that in both the Finnish study and that conducted at Cambridge, allowances were made for smokers and those who consumed alcohol.
In other words, the researchers believe that it is not the byproduct of anxiety — increased consumption of alcohol, tobacco or drugs — that causes ill-health but anxiety itself.
One possibility is that constant anxiety in men causes physical reactions that fire up the body’s defences, sparking off damaging long-term inflammation throughout the body that may cause a wide range of chronic illnesses.
“When we are anxious we get the activation of all sorts of hormones and a part of the autonomic nervous system called the sympathetic nervous system kicks in,” says psychology professor at Trinity College Dublin, and author of the recently published The Stress Test, Ian Robertson.
“That’s the part that gets us ready for fight or flight. It’s a primitive defence system that allows us to prioritise certain things.
"So it makes our heart beat more to prepare us for action. It tenses our muscles to help us either run fast or fight. We breathe faster for more oxygen and it makes our skin sweat to cool us down for that action.
"The digestive system is also affected because the body isn’t prioritising eating as such, it wants you to focus elsewhere. So that’s why people who are anxious often have problems eating or get indigestion.”
Looking at the symptoms of anxiety and seeing how the body reacts to it would suggest that it is a necessary and even desirable part of human survival; as integral as hunger and sex.
Simply put, our cavemen ancestors needed anxiety.
Given the historically different roles of women and men, has a biological difference evolved in how each reacts physically to anxiety?
For Prof Robertson the differences are cultural.
“Exactly the same set of symptoms happen in men and women,” he says.
“But how those symptoms play out depends on how your mind responds. I think men culturally tend to regard these symptoms as signs of weakness, it’s more culturally acceptable for women to admit they’re anxious.
“There’s a reluctance in men because of that macho image,” he continues.
“Women are more likely to talk too and that’s an important way of getting control of your emotions and also giving you another perspective on things.
"Men sometimes get angry or irritable or aggressive or end up drinking a lot.
“How we interpret our emotions does differ. Men often deny their anxiety but their bodies will show it — their blood pressure goes up and their heart rate goes up.”
Though not talking through problems may lead to an increased heart rate and blood pressure, these symptoms are, as Prof Robertson points out, not exclusive to men.
But there may well be a biological response to stress that is.
Three years ago, psychiatrists at the VU University Medical Center in Amsterdam reported in the journal Translational Psychiatry that men who develop anxiety disorders in adult life show significantly raised levels of inflammatory chemicals in their bloodstream.
They pointed to one in particular known as a C-reactive protein (CRP), a powerful defence against infection which becomes harmful if called into action too often over a sustained period of time — a sustained period of anxiety for instance.
In particular, CRPs are linked to a raised risk of developing cancers as well as heart disease and diabetes.
The same team of researchers also discovered that sleep disturbances associated with anxiety can also spark the production of CRPs.
Crucially, this increase in CRPs appears only to happen in anxious men and not women.
So it would appear that although according to the Cambridge study women are more likely to suffer from GAD, the physical effects whether caused by biological or cultural influences are more detrimental to men.
So if men are reluctant to talk about their anxiety, what should they do? Again it seems there is a lot to be said for going back to basics.
“There’s strong evidence to support exercise as the equivalent to medication for mild to moderate depression,” says clinical psychologist Dr Eddie Murphy.
“And linked to that, though it’s not exactly the same, there’s evidence to suggest it helps stress and anxiety.
"Exercise releases endorphins, our happy hormones, which is good biologically because you’re fit and healthy, you’re more resilient and you have more energy after going for a run. But there are social reasons too, being part of a group.”
Prof Robertson believes how we interpret anxiety is key to how we manage stressful situations.
“About three months ago, I had a beating heart, dry mouth and sweaty hands,” he explains.
“I was breathing very heavily. But I wasn’t anxious. Ireland had just scored against Sweden in the Euros. That was excitement.
"Now most people would recognise those symptoms I mentioned as symptoms of anxiety but those symptoms run across various situations including sexual arousal, anger and, as we’ve said, anxiety and excitement. We can control them.
“The evidence is that if you say to yourself ‘I feel excited’ before you do something that makes you anxious — be it a presentation to keep your job or whatever — as opposed to ‘I feel calm’ or ‘I feel anxious’, you’ll actually perform better. And if you perform better you’ll feel better.
“That is like rewriting computer code, it changes you from perceiving a situation as a threat into one that you see as a challenge and the challenge mindset is completely different reorientation of how the brain is functioning.
"It puts you into a different frame of mind and changes your capacity for thinking and the nature of your thinking and allows you to perform well.”
But perhaps the answer lies in something as simple as caveman-like as hitting something. According to a study in the highly respected journal PLoS One.
Researchers at the Royal College of Music and Imperial College London reported that joining a drumming group for ten weeks significantly reduced anxiety and inflammatory responses in men.
No wonder Larry Mullen always looks so happy.
: “Changing the situation is the magic bullet people often look for,” says clinical psychologist Dr Eddie Murphy.
“But we can’t always do it. If you’re looking after a sick relative, you can’t just leave it, but if you are mobile and you’re in a toxic situation, some people choose to change.”
“I’ve seen people change, move from one place to another, but they brought their mindset with them and, subsequently, things stayed pretty much the same. Mindset is the hardest thing to change, but the most effective one if you can do it,”says Murphy, who also recommends cognitive behavioral therapy.
One of the best apps on the market is Headspace Meditation. It’s free to download but you can access a complete programme by paying a subscription.
It may give you an energy boost but drinking too much coffee and tea can lead to irritability and restlessness.
It’s easy to be a slave to the desk and deadlines but 20 minutes spent exercising in the fresh air daily is a sure-fire way to keep stress at bay.
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