Guest: Bill Johnson
Guest Bio: Bill is a registered clinical psychologist, currently working full-time in a private practice. He has helped individuals, couples and groups with counselling, and has worked with numerous clients who have experienced a variety of concerns including anger management, clinical depression, anxiety, psychosis and personal disorders.
Segment Overview: Depression and anxiety manifests differently in men compared to women and this is further elaborated by Bill Johnson in this segment. Diagnosing these conditions vary depending on gender as men more likely display anger when in pain. Take time to listen our topic on anxiety and depression and hopefully learn how to handle these better.
Health Professional Radio
Katherine: Thank you for listening to Health Professional Radio. In Australia, one in four women and one in six men will experience an episode of clinical depression during their lifetime. To talk about anxiety and depression, we have with us Bill Johnson. Thank you for joining us today, Bill.
Bill Johnson: It’s a pleasure to be here, Katherine.
Katherine: Bill is a registered clinical psychologist, currently working full-time in a private practice. He has helped individuals, couples and groups with counselling, and has worked with numerous clients who have experienced a variety of concerns including anger management, clinical depression, anxiety, psychosis and personal disorders.
In Australia, significant levels of depression affect approximately 20% of adults either directly or indirectly during their lifetime. Almost as twice as many women will be diagnosed with the disorder compared to men. Now, Bill, why do you think twice as many women are diagnosed? Are women more pre-dispositioned to depression, do you think?
Bill: I really appreciate that question in particular. I’ve got a few biases here, and one of my biases is that oftentimes, we’re not doing enough within the mental healthcare field to reach out to men who are suffering. My gut … and also some research backed this up, that part of the issue is that men are not seeking treatment as often as women are. The other reason is because some of the signature features of depression and anxiety manifest differently in men than women.
For example, sadness is a signature feature of depression, whereas, anger is not. You look at the symptoms and what characterises the disorder, where anger doesn’t really fit the ideology. Yet, anger is more likely to manifest as a symptom of depression in men than in women.
The other reason is because, I believe, misdiagnosis due to the ways that the symptoms manifest differently across the genders. You got a difference in help-seeking behaviour, you have a difference in the way that the symptoms manifest themselves.
Also, I think there’s the socialisation around seeking treatment. Men are more likely – picture young boys when they are three or four years old, when they fall and hurt themselves. We’re more likely to tell them ‘look, you’re okay. Get up, get on with it’. And so we’ve already reinforced within him the idea that even if you’re in pain, don’t talk about that. As a matter of fact, ignore it, and we’ll all ignore it and we’ll get on with things.
As boys, we grow up internalising that message, and as young men, that message often plays out even when we’re suffering with mental health issues.
Katherine: Right, yeah, definitely, it does. Definitely, if men aren’t seeking help in the first place, they can’t be recorded, and that skews to statistics. Depression can also run in families, with the risk of depression increasing with every first degree relative. That means immediate relatives affected by the disorder. Up to 80% of suicides are reported to be preceded by a mood disorder or depression. Do you find the link with the family, hereditary, in your practice?
Bill: There seems to be a relationship, there’s no doubt about that. What we’re not sure about is that the link is more genetic, or, if it’s more … you emulate what you grow up watching. I have found that to be true. One thing that I often ask clients when they come in is about family history of disorders. The other thing in relation to that is even if there is no history of depression or anxiety, or even mood disorders – depression is a mood disorder – how were emotions dealt with inside the home?
If your parents were frustrated, how would you know that? How were your emotions responded to also while you were growing up? It could be that you’ve learned some dysfunctional patterns of reconciling your emotions because of watching how your parents handled theirs.
Katherine: Right. You mentioned moods as well. I think everyone of us goes through up days and down days, and some people have a few down days in a row. How do they differentiate whether it’s just feeling a bit blue or if it’s something more serious? Because I think people often fail to recognise the symptoms of depression, therefore they can’t get treatment for it.
Bill: Really a good point, and maybe you and I can dialogue about this a bit. Here’s my take on it: I would say that to meet the symptoms of clinical depression, the down mood of feeling depressed, or feeling sad, should last at least two weeks.
But I would say, if it’s starting to have a significant impact on your life, you find it’s tough to get out of bed, you’re not really talking to anybody that you used to talk to, you’re not enjoying stuff you used to enjoy, then I would say, ‘look, why not get treatment right away?’ The worst thing that can happen is that you talk to your GP or you talk to a counsellor, and they say, ‘look, your symptoms are actually quite mild’. That’s the worst thing that can happen.
The best thing that can happen is that you find out that while you’re heading down a slippery slope there, and now that I’m in and getting help with that, I can start to work on things. I would say if it’s beginning to have a significant impact on your day-to-day life, then you really want to talk to someone.
Bill: I want to go back if I can … it’s something else you asked.
Bill: I’m aware that at times, there’s a stigma about seeking treatment, about talking to a counsellor or a psychologist. I would try to compare it to having a chat with a close friend who’s not going to judge you, who’s going to listen to you, and who might have some solutions and ways that you can help yourself.
People who receive treatment for depression and anxiety – they’re not crazy, they’re not different than anyone else. As you say, we’re talking 20% of the population. We’re talking millions of people experience these symptoms. Ultimately, all counselling is, is having a chat with someone who’s going to listen, who’s going to be attentive, who’s going to be responsive, who’s trying to assist you in assisting yourself.
Katherine: Sure. If you have a friend or a loved one that you think may need some help, how do you approach them? How do you even bring this up without them getting defensive?
Bill: Here’s what I’d say: I would say that, one, it’s okay if they … I might even expect for them to not be overly overjoyed by the introduction of needing help, and that’s fine. I would honestly hit them right over the head with it. But here’s how I would do it. I would talk about your concerns about them. Maybe, I wouldn’t say, ‘look, I think you’re crazy, Katherine. I think you need to get some help. You need to be locked up’. I probably wouldn’t go about it that way.
Now, I might say, if it’s you, Katherine, I might say, ‘I’m starting to really worry about you. You know how important our relationship is’. Or if it’s a colleague, ‘look, I really love working with you. I’ve got to admit that I’m feeling worried about some things. How are you going?’ If they brush off the first time, then I would go back again the next day and say, ‘look, I tried to bring this stuff the other day, I’m, again, just a bit worried because I noticed a, b and c. How are things going?’
As they begin to … and even if they don’t disclose anything, then, I would still say ‘one thing that I’ve done’ … and as a psychologist, I’ve done this within my life as well. I found that talking to a counsellor is helpful. So, I might talk about your concerns for them. I might be persistent in my approaching them. Then, I might, after that, I might bring up the idea of them having a chat with someone.
Katherine: Yeah. I know some people who do need help, maybe they are concerned about the cost of seeing a professional. Can you recommend some lower-cost resources for people who may be suffering and they need a starting point?
Bill: One of the wonderful things about the healthcare system here in Australia is that a lot of people have access to mental health services. If you go see your GP, most people – not everyone – most people qualify for the Better Access Treatment Mental Healthcare Plan under Medicare. If your GP decides that your symptoms are severe enough, then they can refer you to a psychologist and you’d receive up to six sessions, at no charge to yourself, under Medicare.
Bill: Otherwise, here’s what I would suggest; I would visit local community mental health centres within your area and tell them of your financial situation, because a lot of places also do scale sliding scale or they’re willing to work with you on payment.
The bigger issue with payment, of course, is how much is your health worth? At the end of the day, I’d rather spend whatever money I needed to spend, if I knew at the end of it, I was going to be feeling the way I like to feel. Does that make sense?
Katherine: Yes, it does.
Katherine: Thank you so much for all your insights today, Bill. For those of you that would like to know more and read more, Bill has a monthly column in the Good Men Project magazine, and that URL is goodmenproject.com. Thank you for providing some practical advice for us today, and also talking about this very serious topic.
Bill: My pleasure, Katherine. Thank you again.