Men’s Mental Health

Elisa A. Escalante/ LCSW/ 6-7-2025

“A man will kill himself before he will ever speak his pain.” -EaE

All I can write about is my perspective as an outside observer to a group of people that exist; my male peers, my male family members, my male clients, and men I’ve dated. First off, there are two major things I’ve always felt sorry for men about. 1- The extreme amount of pressure they are given by society to be providers. (I was a provider for my last two exes including helping one of them with their children, so I know the feeling first hand. The crushing weight/ pressure to perform because people in a household rely on you. But rest assured, for a woman, that’s not the expectation) 2- The other social conditioning; that they are not allowed to cry in front of people. I myself am I cry baby and I couldn’t imagine having to force those tears down my entire life, no thanks. I started working in an Air Force mental health clinic by the time I was nineteen years old. Plenty of male clients. By the time I finished the military and completed social work school in NYC, I found myself working at the Brooklyn Vet center for the next 3.5 years. Vet centers have a strict eligibility; combat veterans and/ or veterans that have suffered from military sexual trauma. As a therapist, this means the highest possible PTSD caseload imaginable. It also means per caseload, the highest number of combat veterans to talk to compared to any other therapist in any other setting.

The Vet center transformed me as a clinician. For one, I was lucky enough to have a great first clinical supervisor who taught me more about how easily Veterans (especially male) hide their symptoms, even from themselves. Plenty of veterans went on to become law enforcement, corrections, fire fighters and other high adrenaline/ high stress jobs. In NYC, there was also the added factor of many of my veteran clients having either witnessed and/ or responded to the 911 attacks. Some therapists might call themselves ‘Trauma informed”, but I became trauma ‘oversaturated’. The first thing that helped bridge the gap is the veterans learned very quickly that I deployed too. But there was the added factor that I did not try to pretend I understood their experience. Truth be told, because I deployed to Afghanistan it just gave me more awareness. I was in a combat zone, but I am not a combat veteran. I was never on the front lines. I can’t pretend to understand, and I won’t try to pretend I understand.

The hardest part when therapists speak with men in general, the walls are already up from day one. It felt like this imaginary brick wall that they put up. Maybe they decided that the only way I would get any information from them is by tearing the wall down, brick by brick. Very slowly, and painfully. I was up for the task of course, in the military they were very guarded because they were literally not allowed to ‘be mentally ill’, it could ‘ruin their careers’.

“I will NEVER do cognitive behavioral therapy again! The VA kept making me do that crap and it was bullshit!”

Because plenty of veterans told me things like this from their initial mental health apt, I realized very quickly that I would need to take a different approach. What many therapists would consider a ‘backwards approach’. I would have to help these guys deal with and manage their symptoms first, and eventually if trust is built, we could link the symptoms back to their root causes; military and/ or childhood trauma. I developed the ability to help people with PTSD without requiring that they share their stories with me in detail. Because a lot of conventional ‘evidenced based’ treatment modalities are too harsh and too rushed. (The modalities that the VA are required to use)

My forbidden phrases:

“Tell me how you feel about that…..”

Consider that men already weren’t allowed to talk about feelings even from a young age. They were highly stigmatized and that question scares them, but the mask they wear might be anger. Especially if you ask them a silly question like that. My approach became to identify their emotion for them and to say it out loud, judgement free. A lot of my male clients appreciated this because I took away the burden. They didn’t have to think about how they felt and then feel added pressure to vocalize it out loud. Me: “Sound’s like you feel jealous”. Or, “Sound’s like a moral injury.” Them: “Oh shit yeah maybe you’re right….” (now moving on…..)

“Speak to your inner child”

I recognize that this is a more common line that comes up now a days in conventional therapy, but there is no way I would ever say this out loud to a male client. There is definitely a way to help people address stuck points, root causes with their trauma and their survival programming without having to converse with this ‘inner child’. Again, men are not necessarily comfortable with anything that feels too ‘touchy feely’. Try not to sound sensitive and try not to sound like you feel bad for them.

“I understand….”

You do not understand. You can’t. It’s okay too. Let’s not pretend to. Empathy means the ability to look at someone’s struggle and recognize that it does look/ and sound difficult. You can have empathy without understanding. If you pretend you understand but he knows that you have not ‘been in his shoes’, he might resent this statement. This goes for all clients, I won’t say I understand. (Even in some cases when I do, I still won’t go there)

Specific Questions:

Without specific questions, you might just miss out on some very relevant information. Questions like: “Have you experienced trauma?” are too broad. From the male clients lens, he may not even recognize that what he went through was ‘traumatic’. I avoided that question and instead asked questions like “What was the hardest part of your military career?” “What was the worse thing you experienced on your deployment?” “What did you like or dislike about your job in the military?” “What was the scariest thing for you?” Most of these questions require answers and do not necessarily require heavy emotional talk. We can be logical about it and just talk about the fact that some things were super stressful and hard.

Talking about Emotions from a purpose perspective

Society decides that there are ‘good emotions’ and ‘bad emotions’. For men, their list of ‘bad emotions’ is even higher versus what women are ‘allowed to feel’. But society cannot change the fact that all humans have a wide variety of emotions. Unfortunately, men are commonly taught to never process, discuss or acknowledge those ‘bad emotions’ and to essentially pretend they do not exist. I am to this day, still impressed by the amount of BS a man will put up with before he explodes and his entire life starts to fall apart. It’s a little scary and we as a society need to do better. So when I speak with male clients, I talk about emotions from a purpose perspective. This is what the emotion is for, this is the message it give’s us, and after interpreting the message, this is maybe what we ought to do about it. My male clients are often both confused and intrigued. As no one has taught them that yes, every emotion does have a purpose. And we can even engage our logical brain to decipher the message.

Sadness: Endorphin hunt, seek joy, seek adventure, do something new, seek social connection, get sunlight, move your body.

Anxiety: Analyze the threat around you, problem solve what you are concerned about, and/ or take precautions. And in some cases, use escapism activities

Anger: Fight the threat, protect yourself, justice seek, or walk away from threat.

Jealousy: Explore what you fear, explore what you are missing out on, or explore what you want/ need more of.

Guilt: Learn from the mistake, correct your actions and try to do less harm next time, have humility, have more integrity, or honor both yourself and others

Numb: Ground yourself to the present environment, use an external stimulus, seek adrenaline (safely of course)