It’s not uncommon to meet fellow gay men suffering from anxiety and depression. It’s also not unusual that they are either unaware, in denial, or unwilling to recognize these challenges, or to take the steps necessary to address them.
Some years ago, I had a falling out with my flatmates. At the time I was directing a major shoot at film school and was under immense pressure. Amid my mad scramble to find a new apartment, I decided to meet Samson*, a gay man in his 20s who worked as an IT consultant.
Having exchanged niceties, Samson quickly got down to brass tacks, advising me he wanted a flatmate willing to hang tea towels and stack dishwashers in a specific fashion.
As someone known for my somewhat OCD tendencies – I for example never allowed people to sit on my bed while wearing their “outside clothes” – I could to some degree relate.
But Samson seemed to take things one step further. A health fanatic devoted to all-natural products, he told me I wouldn’t be allowed to clean with bleach, on the account he might be exposed to its fumes.
Despite my reservations, I took the room. But from that first meeting onward, the stipulations piled up. One minute I was using too much fridge space, the next I was filling the kettle with “excess” water and wasting energy.
Samson even took to switching off the oven when he believed I was using it too long.
While he managed to bend some of his rules for me, I couldn’t shake the feeling that my presence in Samson’s home was not welcome. I could tell that while he wanted to save on rent, but also wanted to live alone.
Worse still, whenever we happened to cross paths, Samson would complain. First, it was about his cutthroat colleagues at work. A week later it was the ex who seemed incapable of empathy, and the friends who failed to understand Samson’s very specific health choices.
Samson told me he was against eating hydrogenated oils, on account of them being carcinogenic. For him, discovering that a meal contained even a trace of such was enough to ruin an entire night out.
Listening to Samson, I felt torn. Some of his complaints were understandable, and yet I knew I was being used as a sounding board for his discontent.
I tried to bring empathy and some perspective to the issues Samson raised, and yet nothing I said or did made any difference. Samson was trapped in a cycle of negative thinking, focused only on assigning blame to others.
So long as he continued to see the apparent failures of others as a reflection of their respect for him – and by implication Samson’s worth as a person – this would likely continue.
Samson’s paradigm was clearly at fault here, but I became convinced that it was serving double duty as a smokescreen for Samson’s inability to manage his own distress.
By pretending it was not there, he would never have to confront it. Yet this unwillingness to accept and recognize his covert depression was precisely what was keeping him stuck. Rather than practicing introspection, Samson searched for scapegoats.
Once or twice I broached the subject of seeing a therapist. Each time, Samson produced a readymade excuse.
The few therapists Samson had approached would not take his health insurance. The nature of Samson’s job meant he was often on the road with short notice, making it difficult for him to plan therapy sessions in advance.
Then there was the question of trust: Samson didn’t want to open up to just anyone.
These were legitimate friction points, ones faced by many gay men looking to undertake therapy. But they were also excuses. As per the old maxim, if you really want to do something, you’ll find a way.
1. Gay men often suffer from depression
An inability or unwillingness to acknowledge one’s own mental health struggles is usually a product of self-denial; of alienation from one’s own authentic feelings.
Like a majority of men, we as gay men often suffer interpersonal prejudice and discrimination over our identities. These minority stresses can leave us stricken with shame while placing us at greater risk of depression, anxiety, and suicide.
That risk is exacerbated by the fact that males are socially programmed to go at it alone. Masculinity is popularly coded as being self-reliant, an idea more widely echoed in our culture’s embrace of rugged individualism, i.e. the “I don’t need help from anyone” mentality (see my earlier article on embracing your authentic gay identity).
Gay men tend to be more emotionally expressive than their straight counterparts. Gender-atypical tendencies like this often lead to us being singled out and persecuted. Any wonder then we should be especially challenged when it comes to asking for help.
But forcing ourselves to repress our emotions and to cut ourselves off from the help of others leaves us prone to covert depression. This depression is often the reason many of us should seek help…and yet it can also serve as a major source of resistance.
Depression sufferers know all too well how we can become trapped in the stasis field of negative thoughts and “automatic”, self-perpetuating cognitive distortions.
In his book Feeling Good, David D. Burns notes that these distortions lead in turn to procrastination and “do-nothingism”. That is, we found ourselves restrained by the very same inertia we are seeking to escape.
Thus the depressive, lacking the motivation to change, surrenders to the comforting familiarity of their unhappiness.
Another reason it is difficult to take action is that covert depression operates as a kind of background presence that evades easy detection, or may be put down to just a passing “mood”.
Similarly, anxiety – depression’s fraternal sibling – may also be dismissed as an inevitable feature of modern life. It may even be regarded as a helpful crutch that gives the sufferer a motivational edge; a willingness to go the extra mile that is recognized and rewarded by employers.
2. We may have attachment difficulties
Caregivers play a crucial role not just in early development but our future wellbeing. They comfort us during times of distress, fostering a sense of security through healthy attachment. That attachment serves as a template for future relationships, shaping whether we are able to form close bonds with others.
Attachment also provides children with an internal working model of self-worth. It defines whether we see the world as a safe or nurturing place, or one full of pain, uncertainty, and anguish. It provides the primary reference point for our lived experience.
Ruptured attachment is the result of either active trauma, which typically involves a boundary violation such as physical or sexual abuse, or passive trauma, which involves some form of physical or emotional lack, such as neglect. Ruptured attachment can occur at any point during childhood or teenagehood.
Gay men experience both active and passive trauma when a parent rejects, neglects or attacks them over their sexuality, an experience which is all too common.
During early attachment, trauma is preverbal, making our suffering literally beyond words. As such, it can be difficult to “re-cognize” the experience and come to grips with its effect on us as adults.
Without the help of a trained practitioner, we will continue to live unknowingly in the shadow of our trauma, afflicted with mental health conditions like depression.
3. We may be unable to self-soothe
Ruptured attachment results in an inability to self-soothe. When our caregivers fail to properly “attune” to us and provide the correct behavioral modeling, we fail to develop this vital skill.
Self-soothing means being able to realize we are hurting, to give ourselves the comfort we need, and to seek it from others when we can’t.
Without self-soothing, we may find ourselves prone to “fight, flight, or freeze” in times of stress.
That is, we engage in one of three coping strategies: coming out guns blazing, running from danger, or shutting down. We don’t seek the support we so desperately need, leaving us beholden to depression and anxiety.
In an attempt to pacify our troubled minds and hearts, we may turn to the Band-Aid fixes of grandiosity or process addictions.
4. Gay men are debilitated by shame
For gay men, depression is often compounded by longstanding shame. The distinction between guilt and shame, as pointed out by Brené Brown, is that guilt involves believing “I did something bad”, while shame involves assigning a permanent negative quality to yourself, like “I am bad”.
We come by shame firstly through socialization. Society teaches us our sexuality is abnormal, perverse, and even morally wrong. When this view is adopted by our caregivers, it may not necessarily lead to outright rejection, but rather words or deeds that are invalidating.
Invalidations, no matter how small they may seem, can inflict profound psychic wounds, Alice Miller says. If the only people in the world duty-bound to love you unconditionally mock or belittle you because of your sexuality, you may come to believe you are inherently unlovable.
The child with a devastating belief in his own unworthiness is likely to carry it into adulthood. If left unaddressed, this belief can leave us relationally impaired, resulting in an insecure attachment style.
Attached authors Amir Levine and Rachel Heller estimate about half of the adult population suffer from insecure attachment styles. In the case of gay men, this figure may arguably be even higher.
How a therapist can help gay men
Therapy is one way we can identify the impact ruptured attachment or invalidation has had upon us. It offers avenues for reconnecting with aspects of ourselves we may have become alienated from as a result of parental and social rejection and invalidation.
And it is through this connection that we develop self-awareness, what Daniel Goleman calls “emotional intelligence”, and thus the ability to self-soothe.
A relationship with a therapist ideally is reparative. They model the unconditional acceptance of an ideal caregiver, creating an accepting space in which clients can vent to thoughts and feelings they have been forced to repress, often as a matter of survival.
A good therapist uses compassion and insight to help their patients reintegrate alienated parts of the self. Through their guidance, gay men can come to terms with the loss and anguish they have suffered.
Therapy requires that we go to places we have been avoiding. After a lifetime spent mastering the art of emotional concealment, gay men undergoing therapy are asked to forgo their craft and expose their wounds and weak spots.
Embracing vulnerability in this fashion allows us to ultimately regain our long-lost ability to be emotionally authentic.
As Buddhist Pema Chödrön points out:
Without realizing it we continually shield ourselves from this pain because it scares us. We put up protective walls made of opinions, prejudices, and strategies, barriers that are built on a deep fear of being hurt… Finding the courage to go to the places that scare us cannot happen without compassionate inquiry into the workings of ego… Either we question our beliefs – or we don’t. Either we accept our fixed versions of reality – or we begin to challenge them.
Choosing a therapist
Making the decision to undergo therapy sometimes feels like half the struggle. Then you have to deal with the deadly triad: money, scheduling, and what Samson called trust, but which I like to think of as compatibility.
You can’t put a price on your mental wellbeing, so don’t let the cost alone thwart your efforts. If you don’t have a mental health care-inclusive health care plan, consider finding a therapist who offers sliding scale fees. If you need to take time out during working hours, negotiate with your manager or HR department.
When choosing a therapist, we all need assurance that we are in safe hands. We are, after all, seeking the unconditional acceptance we were once denied. Our chosen confidant, therefore, needs to show they will honor this responsibility.
Bessel van der Kolk suggests three criteria by which you can gauge this: comfort, curiosity, and collaboration. To that list, I would also add proactivity and accountability:
- Comfort: Do you feel comfortable and safe in the presence of this therapist? Do they seem comfortable with you? In the words of van der Kolk: “Someone who is stern, judgmental, agitated, or harsh is likely to leave you feeling scared, abandoned, and humiliated, and that won’t help you resolve your traumatic stress”.
- Curiosity: Does the therapist seem interested in you as a person? Or do they see you as just another patient to be handed a rote list of advice and instructions? Do they actually listen to you? Are they comfortable sitting with your distress? Or do they immediately leap into diagnosis and prescription?
- Collaboration: Is the therapist demonstrating a genuine desire to work with you, to explore your issues in-depth and to formulate a treatment plan?
- Proactivity: Some therapists tend to take a nondirective role. As a result, you may feel you have to overcompensate. Sessions may become endless talk marathons, broken only by you prompting your therapist for participation. There is great value in a sympathetic ear, and venting is definitely part of the process. But given for example depression’s tendency to keep us trapped in automatic thoughts, we are never going to make the necessary shifts in our thinking without the help of someone willing to interrupt, redirect and even challenge, where necessary.
- Accountability: Does your therapist honor their appointments with you? Do they cancel or reschedule on short notice? A therapist who is unpredictable or inconsistent can’t provide you with the security and caregiver-like “containment” you need. This also works in reverse. Do they help keep you accountable? Set tasks and homework? Without proper follow through on your behalf, your recovery may be hindered.
Remember: you are not locked into any therapist relationship. Treat the first session and those that follow like you would a date. You may be seeking immediate relief, but your objective should be to assess compatibility.
In the end, there is no use building a relationship with someone who isn’t capable of giving you the support you need. Be willing to shop around until you find the right fit. And if it isn’t working, be prepared to move on.
As with any endeavor, you will face setbacks. Sometimes these setbacks may simply come down to lack of motivation. If this is the case, break the task of finding a therapist into baby steps and try to complete one step a day.
The act of unlearning maladaptive behaviors and patterns can take months, if not years. Your recovery ultimately comes down to your being patient with the journey, flexible in your approach, and perhaps most importantly, remaining committed to your wellbeing.
Creating a new self unburdened by the injustices of your past first requires that you choose to break with the old.
“When I let go of what I am,” says Chinese philosopher Laozi, “I become what I might be”.
For advice on finding a therapist, check out this handy post by the American Psychological Association.
- Acknowledge you may have depression.
- Consider how your attachment history and feelings of shame might be playing a role.
- Fight motivational inertia! Take it one baby step at a time.
- Stay committed. You're in this for the long haul.
* Names and identifying details have been changed to protect the privacy of all individuals discussed in this article.
© 2022 Ehsan "Essy" Knopf. Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity, unless explicitly stated. All content found on the EssyKnopf.com website and affiliated social media accounts were created for informational purposes only and should not be treated as a substitute for the advice of qualified medical or mental health professionals. Always follow the advice of your designated provider.