'Gerald seemed so remote when it came to talking about his feelings'

Gerald was difficult to reach at first, in the virtual space you have to occupy together via a screen if you wish to conduct therapy right now. In my clinical experience, men can be emotionally elusive. They can have difficulty finding the words to express their state of mind, or find their feelings shameful and are reluctant to share them. Unexpectedly though, in Gerald's case at least, he felt less confined making contact in two dimensions, rather than three. 

Gerald attended his tele-therapy sessions in his car where he had some privacy… better than his small flat, where his problems were getting out of hand. He was now out of a job, he had mounting financial problems and his marriage was in trouble. His wife felt provoked by his silent brooding, and they were arguing a lot. She scorned his lack of dynamism, which brought back painful memories of humiliation, and they were both concerned by the intensity of their exchanges. 

At first I was pessimistic about whether online therapy could help Gerald, who seemed so remote when it came to talking about his feelings. But I was soon proved wrong. One of the things I've found in doing 'tele-therapy' – sessions via telephone or video – is that some patients find it easier to open up when they are not in the room with me. It's like the screen offers some protection, and the physical distance allows them to be more emotionally engaged. Friends in the business world tell me that their office's introverts are actually contributing more to team meetings via video conferencing than they did in the boardroom too.

This has led me to consider therapy's emphasis on sharing intimate feelings, and how some patients may require a more nuanced approach in order to receive the help they need. Simply 'opening up' is not easy for many, and can be counter-productive if forced. This applies especially to men, who are generally less skilled at verbalising their emotions. There is empirical support for language acquisition favouring girls over boys.

Thwarted in lockdown

Gerald himself was especially desperate. It felt like he was talking to me from 'the last-chance saloon'. And within a session or two, he relived the distressing trauma of being the victim of sexual abuse, which he had kept out of his mind for 30 years. This lay at the heart of his feelings of emasculation, which was now exposed by his sense of being thwarted in lockdown.

Not everyone enduring relationship issues during the quarantine will be carrying a burden of significant trauma. But Gerald's case is in my experience typical of a tendency in men to find it hard to articulate what is in their heads, either because it feels shameful or because a lexicon of emotional language is not available to them. Prince William's campaign to encourage men to acknowledge their mental health needs is particularly welcome. The notion that women's independence will be the silent victim of the pandemic is, in my view, simply wrong, but the voices of reason which hold a different point of view are less prominent.  

A recent Office of National Statistics (ONS) survey during the pandemic unsurprisingly found rates of anxiety to be higher than normal and feelings of well-being reduced. But men are apparently less affected, or so the data suggests. One Spanish study at the beginning of the outbreak found that women are more likely to tweet about social distancing and healthcare, whereas men are more likely to tweet about cancelled sports events.

Is this because men are frivolous and don't care about what is important during the worst crisis in living memory? Writing in The Daily Mail, Janet Street-Porter thinks so. She recognises gender inequality in the mortality rates of Coronavirus, but declares that it is women who bear the brunt of the misery. In her 'Week in Patriarchy' column in The Guardian, Arwa Mahdawi attributes the finding that men are less likely to wear face masks to toxic masculinity. Granted, Mahdawi has a point: men take more risks, and maybe feel shame about the new facial apparel. But this is not 'toxic masculinity', which is a term we should reserve for the worst excesses of destructive male behaviour.

Deaf to difference?

These divisive opinions serve only to reinforce the gender divide at a time when we should be coming together and understanding our differences, rather than tearing ourselves apart. The ONS attribute higher anxiety in women to men being more economically active. I think it more likely that male respondents are masking their feelings. Surveys ask simple explicit questions like 'Are you feeling more anxious?', and they favour verbal articulation. People express their conflicts in different ways and, without overgeneralising, I would argue that gender plays a role in this. If we remain deaf to difference, or worse condemn it, the needs of vulnerable groups are ignored. 

A global crisis such as this is a slow-release trauma. We pass through the first phase of this pandemic, health and financial devastation left in its wake. Then as the dust settles the real socio-economic ordeal begins to reveal itself. Just like soldiers in wartime are absorbed by the fight and only show the signs of trauma when they emerge from combat, so too the real psychological costs of Covid-19 will show themselves in the months and years ahead. 

But this trauma will need an outlet at some point. The lessons from the wars of the 20^th Century, when the soldiers returned to civilian life, are salutary. Research shows that people who have experienced trauma but don't talk about it are at increased risk of physical health problems later on. Confronting traumatic experiences by discussing them has positive health benefits and lessens this risk. 

Men may be lamenting the absence of sport, but what appears as trivial folly belies a deeper truth. The Samaritans have raised concerns over the 'hidden victims' amongst poorer middle aged men who are most at risk of suicide in this pandemic. The action of taking your life is but the tip of an iceberg which conceals an underbelly of unarticulated agony, now made worse by the fear of death, economic anxieties and profound uncertainties about our futures.

How do we explain the shocking proliferation of domestic abuse during the Covid-19 crisis? Estimates in recent reports in the UK suggest a 25% increase, and these are matched by similar figures from around the world. The usual narrative, which explains partner violence according to the male need for dominance and control, is inadequate in understanding this worrying health and criminal justice pandemic. These statistics are symptomatic of underlying problems and they ought to be treated as information to make sense of, rather than simply as an obstacle to overcome. Understanding the reasons behind the issue will provide the best basis to treat it with.

A crisis of epic proportions

Measures to reduce the chances of infection risk a pandemic of despair, which we are now beginning to see more clearly. Violence is symptomatic of alienation. Men tend to be on the wrong side of gender inequality when it comes to negative health and education statistics. In normal times, women tend to go to the doctor if they feel unwell, whereas men will ignore their symptoms. Men in contrast find it hard to come and talk about themselves and fewer access psychological therapies.  

In this time of crisis, men and women are going to have to help one another to manage the challenges caused by health anxieties and the devastating economic, social and psychological consequences of lockdown. If your sense of potency is derived from your work, and with being the breadwinner, how do you respond when you are thwarted in that pursuit and have to stay at home? The workplace may be a refuge, what do you do without it? The findings of the sociologist, HA Bulhan, are salutary. In the 1980s he showed that for every one per cent increase in unemployment this consistently corresponded with an increase of 2% in mortality figures, 6% increase in homicides and imprisonment, and 5% infant mortality. We have a crisis of truly epic proportion on our hands.

Every voice needs an ear

It took patience to establish with Gerald a secure setting which enabled his vulnerability to gradually surface. Our wider culture, from therapy to workplaces and social media, favours verbal expression and risks alienating people who simply aren't very skilled, or experienced, at talking over their innermost feelings. 

We are all in this one together, and every voice needs an ear.

Dr Stephen Blumenthal is Consultant Clinical Psychologist & Psychoanalyst at the Portman Clinic, Tavistock & Portman NHS Foundation Trust, and Queen Anne Street Practice.

With contributions from Steve Beale, freelance journalist.