Episode 364: Men’s Mental Health
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You're listening to the Sex and Psychology Podcast, the sex ed you never got in school and won't get anywhere else. I am your host, Dr. Justin Lehmiller. I am a social psychologist and research fellow at the Kinsey Institute and author of the book, Tell Me What You Want, The Science of Sexual Desire and How It Can Help You Improve Your Sex Life.

A growing number of men are experiencing mental health struggles. However, many of them are not getting the help that they need. Surveys from all around the world find that men are very reluctant to talk about their mental health, and as a result, their mental health issues often go undiagnosed and untreated, and many turn to unhealthy coping mechanisms instead. So in today's show, we're going to open up a conversation about men's mental health. Some of the topics we're going to discuss include the most common mental health concerns facing men today,

factors that influence men's mental health, how a man's sex life affects his mental health, and vice versa, as well as tips for managing mental health, including how to develop better emotion regulation skills and how to deal with stress in healthier ways. I am joined by David Kalili, a licensed marriage and family therapist, board-certified sexologist, and founder of Rouse Relational Wellness, a boutique couples and sex therapy center in San Francisco.

He is author of the Mental Health Workbook for Men and Sex Warriors, a mindfully queer guide for men's anxiety to sex and dating. This is going to be a fascinating and informative conversation. Stick around and we're going to jump in right after the break. Do you want to learn more from me in the form of an online or in-person course? Become sexceptional by getting certified with Sexual Health Alliance, where you can learn from yours truly and a number of top sexuality scholars.

Each year with Sexual Health Alliance, I teach courses like fantasies around the world, as well as immersive study abroad classes in several exciting countries. Join these programs and become a certified sexuality professional at the same time.

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Hi David and welcome to the Sex and Psychology Podcast. Hi Justin, nice to meet you. Thanks for having me. Nice to meet you as well. Thank you so much for joining me. So you wrote a book called The Mental Health Workbook for Men. So let me start by asking why you decided to dedicate an entire workbook to the mental health of men.

So I've been in mental health for about 15 years and sexual wellness for about 20 years. And during that time, I definitely noticed a lot of the ways that men have some unique challenges around mental health and sexual wellness. Also, as someone who is queer identified myself and coming from a mixed race background, I was also noticing how there were these added layers of complexities depending on what are the intersecting identities that are going on there.

And so in my work with men over the years, I've noticed some heightened anxiety around some of the expectations that they believe that they should have for themselves or that they think others have or that others do have of them. And then this like pressure to perform or to show up or to kind of bestow some pleasure or some good things to other people.

which led to a bunch of other issues and other concerns. And so I found myself kind of repeating these same things with different clients around ways to break down shame or ground yourself with anxiety or different aspects of masculinity that I kept hitting up against. And then thankfully, Callisto Press reached out for me to write this book, and I had some of the material already ready to go, and I just hit the ground running and put it out there.

Well, thanks for sharing that. And I think it's a very important book. So before we get into men's most common mental health concerns, let me ask you to elaborate on what you mean by the term mental health. So how are you defining mental health and how is mental health different from, say, mental illness?

The way that I see mental health is it's a combination of three domains, the psychological, social, and emotional. And for us to feel mentally healthy, we need to make sure that those three domains are nourished and resourced. So the social piece would be, what's your relationship with your family, your romantic relationships, your work relationships, friendships, things like that.

Emotional, you know, what are the moods and emotions that you're carrying with you? Are there any themes or patterns? And then psychological, how are you thinking about yourself? How are you thinking about yourself in relation to the world?

The mental illness part would be if there's any extreme situations or deficiencies in any of those areas. And the reason why I like to think about it in that way is it looks at kind of the holistic, the whole picture, rather than saying what's wrong with that person or what's within them that needs to be fixed or adjusted. So by looking at the whole picture, we can see like, is it something that needs to be internally adjusted or is there something within your environment, your boundaries, the way you're operating the world?

that can be adjusted. And then we go from there. So it sounds like mental health is a pretty broad and multifaceted term that encompasses a lot of different things. And I appreciate the way that you describe it, because I think when we hear the term mental health, a lot of people tend to think of it through a more simplistic lens than that. And so it is important when we're talking about mental health to think of it holistically through all of these different dimensions of it that exist.

Agreed. Yeah. So what are some of the most common mental health concerns facing men today? And are these mental health issues that are facing men, are they changing or have these things kind of always been there? Yeah. You know, the ones that really pop to mind right away are for sure loneliness. That's a big one that's

referred to as an epidemic. Thankfully, there are many organizations throughout many countries that are working on that, specifically for men. The relationship to vulnerability, I would say, is another one. And that one is changing, thankfully. You know, the relationship to vulnerability where the kind of old school version of masculinity, where it's very independent, you

rugged, self-reliant individual, the idea of vulnerability is only put in the definition of weakness.

And some of the work that I've had to do, and I know many other therapists or people that work with men have to do, is helping expand the definition of vulnerability. And so to share that, you know, vulnerability isn't an all or nothing thing. It's something that deserves to be brought out with the right audience. I tell people, you know, you don't share your vulnerability with everyone. Not everyone deserves it. And so there's some work around kind of adding some nuance to the definition of vulnerability.

the pressure to provide and perform, it's increased, I would say, in some ways. You know, there's some really good, some views and frameworks out there to help release some of the pressure around the pressure to provide and perform. But I think also it's kind of showing across all genders in a lot of ways, given kind of where we're at with our late-stage capitalism. So that one can be a little iffy to say, you know, this is a mostly masculine thing rather than this is a survival thing that's happening right now.

But under the context of masculinity, the pressure to perform and provide coupled with the lack of reaching out for support or kind of putting vulnerability in this bad box, that combination can really cause like this internal explosion, you know, that leads to anger and explosiveness, or it leads to depression, hypochondria, where guys start to internalize and somaticize their feelings, and then, you know, may or may not go to the doctor about that.

So yeah, I would say that those are the big ones, the loneliness, relationship to vulnerability, and then the pressure to perform and provide. Yeah, and loneliness is one that does seem to be increasing in terms of its prevalence. Like, we're hearing a lot more about men today and loneliness, and we know that that has a lot to do with a growing number of men who are struggling with the ability to form sexual and romantic relationships. And so

You know, this is connected to the whole discussion about incels that we've been hearing about in the popular media that's grown over the last decade. A lot of guys are just kind of really struggling with this because they don't feel that they have a place to fit in in the world in terms of having typical sexual and romantic relationships with other people. And so that's led to the formation of some of these online communities where people end up actually kind of forging an identity around their inability to form the kinds of relationships that they want.

Absolutely. Yeah. And then what ends up happening is it provides them that community and that feeling seen, feeling like they're belonging to something, but in this way that's just kind of reifying their distancing from others and this notion that they're always going to be single or they're kind of this victim or this target in some way. And I had this great chance to share a stage with Dr. Carol Queen in November. And for those that don't know, she's one of the co-founders of Good Vibrations. And it was a great opportunity to share a stage with Dr. Carol Queen.

It was a Ask a Sexologist talk in San Francisco, and someone in the audience asked, I forget the exact words, but essentially, like, why are the young folks having less sex these days? And that's also pertaining to why there's so much loneliness. And I'd hate to sound like a boomer waving in the air, but as someone who grew up with the internet and with the internet growing into popularity, I do think that our easy access to

quick fixes to dopamine to whatever really does have an impact on our loneliness and, you know, reliance on apps for dating rather than trying to meet people in person, you know, really does kind of increase that. But if we can find those communities that are healthy and nourishing and they're online, then that also works too.

Right. So, you know, I was going to ask you what's behind men's mental health concerns. And, you know, we've kind of hit on a few of the factors here, right? So one of them is just the fact that the world today is different from how it used to be. And increasingly, we're spending a lot of time in digital spaces as opposed to interacting with people in person. But I think, you know, something else that's also changed is that

our relationship with sex and dating is also much more fraught than it used to be, right? And that's part of what's contributing to this loneliness epidemic, which is that lots of people feel like they can't find sexual and romantic relationships anymore. But, you know, what's sort of

behind all of that. And you have these broader social movements, you have economic changes like women's greater economic independence and less need or reliance on relationships with men. And so all kinds of things have changed in the world that might be contributing to us being in a different place that is then creating different mental health issues. And of course, pornography and all these other things might play a role as well. And also just changing notions of masculinity too. Yeah.

Yeah. And changing acceptance to relationship structures. I have some friends in San Francisco that identify as monogamous and they're having a hard time finding anyone monogamous here and vice versa. I have friends that are in Denver or wherever, and they're having a hard time finding poly folks and they're just finding monogamous folks. And that leads to this distress. And do I have to move? Do I have to change my whole life just to find the right partner? And yeah, there's a lot of, a lot of factors in there.

Yeah. And as you mentioned, you know, there can also be these factors that are kind of unique to where you live, you know, to not just the broader culture in which you exist, but also the locale in which you live and the available pool of partners who are there and they might want different things than you want. And so it's a complicated process.

task, finding sort of the right fit for you in the world today. And for some people, it does seem very difficult, very challenging, and it exacerbates some of these mental health outcomes.

Now, since this is a podcast about both sex and psychology, I wanted to talk for a bit about the intersection between sex and mental health. So can you tell us a little bit about some of the ways that a man's sex life can affect his mental health? And conversely, what are some of the ways that a man's mental health can affect his sex life? Because it doesn't just go one direction. It definitely goes both ways. Yeah. So sex life impacting mental health is

The big one that I've seen, and I know that you've seen, I guess my hope would say that this is reduced, but straight up the amount of suicide attempts that men have because of performance anxiety or erectile dysfunction is very upsetting and unsettling. It shows the amount of internalization that happens of just putting so much pressure on something that makes up maybe 5% of you, if you're lucky. Yeah.

And the other one would be, you know, obviously performance anxiety would have a big impact. And then how do they talk about it with their partner? Do they talk about it with their partner? How does their partner react? The more internally they can get about it, the more of that narrative that they start spinning starts to get really reified and ingrained.

that can have an impact on their mental health where they start to potentially extrapolate it to other parts of their life. You know, they think they're less of a man or less attractive or less worthwhile because of performance anxiety or less competent in other areas because of their performance anxiety. If they've fallen into the trap of like the quantity of sex that they've had, and I would say that the social emotional piece where they're competing or comparing and despairing with other people,

It's where their issues with sex start to get added to this bigger narrative of who they are as a person and what they can offer, what's their worthwhileness, as it were. And then, you know, what is the mental health aspects that can impact sex?

I'm in the Bay Area, and so I work a lot with people that are under a lot of pressure to perform in their jobs, regardless of industry, and trying to make it by. And so that work stress and the burnout, obviously, can have a huge impact there.

And making the connection that this work stress and burnout is impacting their sex life is not easy for everyone. For a lot of people, they are either in active denial about it or they're just kind of so ingrained in it. And I used to be in this when I, especially in grad school, would just get, you know, just like in it and was not, didn't have the time and space to take a step back and see how I was impacted.

You know, mental health that impacts sex life, you know, also the relationship issues. So are there arguments that are happening in the relationship? What's the respect like for one another? How do they talk to one another? Do they feel considerate of one another? What's the consent practices and boundaries and things like that? What's the use of power in a consensual way sort of thing would definitely be an impact on their sex life.

And then, you know, obviously anxiety and depression. One thing that I really love talking about with people and working with people is helping them identify their attachment style and their trauma response. And I'm not the first one to do it. You know, emotionally focused therapy really focuses on this. But I find that that just really, really helps people understand how their mind, their body, their emotions can really affect how they're showing up in sexual and romantic arenas.

Yeah, you know, as you were speaking about this, a couple of things came to mind. One is how, yes, depression and anxiety are things that often reduce libido for people. Conversely, for some people, they actually increase it, right? Because different people respond to depression and anxiety in very different ways. And so I think there's often this assumption that it's necessarily going to lower libido, but that's not necessarily the case. And then there's also when you layer in the treatments for things like depression and anxiety, and you're

If you're taking medications, that can also have an impact on your sex life as well.

And one other thing that I was thinking about when you were talking was how we have this tendency to compartmentalize different aspects of our life. And we put sex in a different bucket than work. And we put our relationship in a separate bucket. And it's like, no, all these things are interconnected in some way. And there's all kinds of spillover. And so, yeah, as you said, making that connection between what it is that's going on in your life and how that's impacting sex.

sometimes is challenging for some people because they're so compartmentalized. But again, we really need to look at these things holistically and how there is all of this spillover between all the different facets of the self and different aspects of our life and how anxiety problems in any one area can spill over and have negative effects or consequences for sex.

Our tagline at Rouse Relational Wellness is, shame less, love more. And I find that it really helps reduce the shame when you can help people identify and know what really is

external to you that is adding stress and all of these concerns to you. It helps them feel less poor. I don't want to curse, but like less like a piece of shit, I guess, if I can say that, you know, some people would get really internal and say like, oh, I'm so horrible at this. Like, no, no, let's look around. Let's look at what's actually happening. And then we can identify what can be changed, you know, what's within your locus of control.

Yeah, and we need to recognize that, you know, if you have one aspect of your life that's falling apart, like let's say things are going terribly at work or you recently lost your job or something else, why is there that expectation that you should still have a perfect or great sex life? You know, what else is happening, right? There's always consequences because there's this cascade effect of stress problems in one area. It creates a broad physiological response throughout the body and the brain, and that's going to impact everything.

all other aspects of your life, including your sex life. So I wanted to dive into some tips for men who are dealing with mental health issues. And I want to talk about the different aspects of mental health in turn. So let's start first with emotional mental health. So a lot of men struggle with emotion regulation because a lot of guys learn that emotions are something that you're supposed to suppress. So can you share some tips on how you might go about building up emotion regulation as a skill?

Absolutely. Yeah. You know, I think one of the first things to do, which can be the hardest, is to identify what are the early warning signs for these emotional outbursts. And one way to do that is what's called chain analysis. It's through dialectical behavioral therapy and

Let's say you take the moment at the grocery store that you exploded for seemingly no reason. And then you kind of work your way back, maybe 12 hours, 24 hours. And just all the things that are the different thoughts that popped up, the different moments that popped up, the different things that your partner or your boss said to you that elicited a different reaction and whatever.

look at it as like a stacking of things. And it feels like in the moment, this just sudden shift, but in reality, it's this gradual buildup. And I remember when I was in high school and I had a panic attack, my doctor at the time helped me really understand that, that panic attacks start like 24 hours before they actually show up or 12 to 24, something like that. And so, you know, helping identify the early warning signs, you know, if we have to get

Real down to the basics, we can pull out the emotions wheel and the gingerbread man where they can, you know,

Name their emotions and then name on the gingerbread man where they feel it in their body. Something called state-dependent learning is also good. So when you're in that really heightened emotional state, if you can, and it takes practice, and I'll get to that in a second, but if you can take a moment and scan and see, okay, how am I holding this in my body? Are my fists tightened? Are my shoulders up to my ears? Is my jaw really tense? Things like that.

But I think overall, you know, there's these tips and tricks, but I think also what I've noticed with guys, and it's because of this, this pressure to just know that, you know, really encouraging them to practice and encouraging them that there's going to be this, this learning curve and that's okay. And to not give up because it didn't work the first time and try to find analogies of, okay, when you started skateboarding, you probably fell down a bunch of times. So, you know, but you kept at it.

Working out, you need to break muscle in order to rebuild it and things like that. And so helping them understand that it's okay to learn, it's okay to make mistakes, it's okay to feel frustrated in the process, but it's important to keep going.

Yeah, I think that's all really helpful advice. So let's talk about psychological mental health for a moment. Now, a key aspect of this is stress and how we manage it. And again, that's something that a lot of guys struggle with. For many men, they've learned to just kind of grin and bear it and take whatever is thrown at them, even if they don't have the capacity for more.

And I've personally seen this with a number of men in my life, and they just end up in this perpetual state of burnout. And I'm not saying this is unique to men. It certainly happens to women as well, but it is a common issue for guys. The problem that often happens is that when they're in this perpetual state of burnout, that leads them to turn to unhealthy coping mechanisms like substance abuse, right? So stress can lead to burnout, can lead to unhealthy behavior, and all these things are connected.

So what are some tips you can share on how men can deal with and cope with stress more effectively? You know, I think having a good baseline routine of how you take care of yourself, you know, whether that's your morning routine or your hobbies, your social support, things like that, where, you know, you're really nourishing yourself can be really helpful to counteract the stress. Emily Nagoski in her book Burnout talks about it wonderfully about, you know, how you have to kind of complete the cycle of

And so I talked to some people about this by saying, when you're taking on stress, you are taking it on. You are kind of storing it in your body and there needs to be a way for you to get it out.

And so that can be exercise or it can be active rest and working with them to identify what that could be for them. You know, for some, thankfully, you know, in San Francisco, we have these steep hills and they can just kind of bomb up the hill and exhaust themselves over and over again. Others don't want to run. And so it's, you know, coloring, it's gardening, it's things like that.

But then also, you know, aspects of stress. I like to talk to people about resiliency and how Rick Hansen describes resiliency, where he says that resiliency isn't just taking every hit that you get. It's actually knowing your capacity and knowing your availability and things like that and being able to communicate that.

And so checking in with yourself of how much things are you saying yes to? How many projects are you taking on? How many things are you taking on that you've come up with yourself? I'm kind of talking to myself right now, you know, kind of coming up with ideas and be like, yeah, I'm going to do that. And then taking it on and adding more to your plate and then helping them identify who in your life can you talk to about this? Do you want to talk to about this that you feel comfortable talking to about this?

And then if they have that unfortunate thing around, you know, they see vulnerability as just a weakness, then I would really break it down with them to try to help identify like, who can you talk to about this? And what is the item that you want to talk about? And we can start small. We don't have to, you know, do a big revelation and just see how that feels and go from there.

Yeah, you know, my next question to you is actually going to be about vulnerability because I find that that's such a tricky area for a lot of men to deal with, right? Because there's kind of this situation where a lot of men today feel like they're damned if they do and damned if they don't when it comes to vulnerability. So on the one hand, they worry that it might be seen as a sign of weakness if they're vulnerable. And on the other hand, they worry that explaining how they think or feel that they're going to be dismissed automatically.

maybe is mansplaining or criticized for it. And so, you know, the end result is that a lot of guys just don't really talk about their feelings with others, even with their romantic partners, because they're just worried about, you know, if they do this and put themselves in that position of vulnerability, that they're just going to get shut down. So yeah, vulnerability, I think, is one of those really tricky areas. And I know you mentioned that men's relationship with it is changing, and we're certainly talking about it more, but the struggle is real for a lot of men.

Yeah. You know, and not everyone, regardless of gender, knows how to respond to men's vulnerability or vulnerability in general. And then I think that that adds to the shame that the guy feels when they do try to be vulnerable and then their partner or their friend is just kind of staring at them blankly. Or some people have also bought into it and are disgusted by it when they see men being vulnerable. And so I don't want to deny the reality of that.

So it's finding your audience and finding the way that you deliver. I think the other thing is that some people and some guys can treat showing vulnerability as like this...

This demand or this, yeah, I would say a demand where, you know, they don't have the permission or consent piece around like, hey, can I share this with you? Or, hey, do you have a moment? Are you resourced for the emotional labor? However, however, California, you want to put it. And they'll just kind of enter the room and say, oh, my God, I'm so stressed out with work and I can't believe this person. And they just unload and trauma dump or dump.

and then they expect their partner or friend to just right away jump on it and join them. And so also kind of having this psychoeducation or kind of thought thinking through, you know, how do you open up that conversation can be good too. And I think that's where your workbook can be very helpful because it has exercises around how you can cultivate more vulnerability and also how you can do all of these other things that we've been talking about, you know, managing stress and regulating emotions.

when it comes to something like vulnerability specifically, we often hear relationship advice to men along the lines of be more vulnerable. But I think that that's overly simplistic and we need to have a more nuanced conversation about how you present and show up and be vulnerable. And in what situations do you do that and finding the right audience for it? And so it's much trickier than just saying be more vulnerable.

Yeah. If I have a client that is a lawyer, I'm not going to tell them to be more vulnerable at work. We're going to think it through a bit differently. And again, that's where your book comes in handy. So thank you so much for writing it. And I will be sure to include a link to it in the show notes. And I'm really looking forward to continuing our conversation in the next episode and talking more about men's relationship with sex and dating today.

Thank you so much for being here with us, David, and for sharing all of this great information. Can you please tell my listeners where they can go to learn more about you and your work? Absolutely. You can find out more about me at my practice's website, Rouse Relational Wellness. It's rousetherapy.com, R-O-U-S-E therapy. Also, Rouse Therapy on Instagram and TikTok. Great. I will be sure to include all of that in the show notes. So thank you again so much for your time. I really appreciate having you here. Thank you. Thank you.

Thank you for listening. To keep up with new episodes of this podcast, visit my website, sexandpsychology at sexandpsychology.com or subscribe on your favorite platform where I hope you'll take a moment to rate and review the show. If you listen on Apple Podcasts, please consider becoming a Sex and Psychology Premium subscriber to enjoy ad-free listening for just $3.99 a month.

You can also follow me on social media for daily sex research updates. I'm on Blue Sky and X at Justin Laymiller and Instagram at Justin J. Laymiller. Also, be sure to check out my book, Tell Me What You Want. Thanks again for listening. Until next time.