From time to time, a tragedy occurs that leaves a nation stunned.
Families are lost, communities are shaken, and the public is left grappling with an uncomfortable question on how it could have happened.
One such incident was the recent tragedy in Kuantan, Pahang, where an entire family was lost in a suspected murder-suicide.
In the aftermath, neighbours often describe the individual at the centre of such incidents in almost identical terms: that he was quiet, friendly, responsible, devoted to family and seemingly ordinary.
There were no obvious warning signs.
Nothing appeared dramatically wrong.
Yet, beneath this appearance of normalcy, something had clearly gone terribly awry.
While investigations must rightfully take their course and conclusions should never be rushed, such incidents invite us to reflect on a broader and deeply concerning issue that receives far less attention than it deserves, i.e. the hidden mental health crisis among men.
Different presentation
Across many societies, including Malaysia, men are significantly less likely than women to seek help for psychological distress.
Yet, paradoxically, men account for the majority of suicide deaths and are disproportionately represented in severe acts of violence directed at themselves, or in rare cases, those closest to them.
This paradox suggests not greater aggression alone, but something more troubling, in that their suffering remains unseen until it reaches a crisis point.
Public understanding of depression still tends to revolve around visible sadness, tearfulness or emotional openness.
However, men frequently experience and express psychological distress differently.
Depression may present as irritability rather than sadness, anger rather than despair, withdrawal rather than crying.
Sleep disturbances, chronic fatigue, increased alcohol use, risk-taking behaviour or emotional numbness may become the dominant features.
Because these signs are easily mistaken for personality traits, stress or temporary mood changes, distress often goes unnoticed, even within families.
Many men themselves do not recognise that they are experiencing a mental health condition.
They may interpret their struggles as personal failure rather than illness.
Instead of asking for help, they try to endure in silence, believing that perseverance alone will resolve their emotional pain.
Social expectations
From an early age, boys are frequently taught, subtly or explicitly, that strength lies in self-reliance.
Emotional vulnerability may be discouraged.
Expressions of fear, sadness or helplessness are sometimes met with reminders to “be strong” or “man up”.
Over time, emotional restraint becomes intertwined with masculine identity.
As adults, many men therefore develop strong problem-solving abilities for external challenges, but limited skill in addressing internal struggles.
When faced with financial pressures, marital conflict, employment instability or caregiving responsibilities, they may feel compelled to carry burdens alone.
In Malaysia, rapid social and economic change has intensified these pressures.
Rising living costs, job insecurity, debt obligations and shifting family roles have altered traditional expectations of men as providers and protectors.
For some, financial strain does not merely represent economic difficulty.
It becomes a perceived loss of dignity, competence or purpose.
Converging factors
Stressful life events such as jealousy, relationship conflict or financial hardship, are common human experiences.
The overwhelming majority of individuals facing such challenges do not become violent.
What differentiates those who cope from those who collapse is rarely a single trigger.
Rather, it is the interaction between external stressors and internal vulnerability.
Untreated depression, accumulated stress, personality factors, substance misuse, social isolation and limited coping strategies may gradually converge.
Over time, thinking patterns can become increasingly rigid and pessimistic.
Problems begin to feel permanent. Options appear to narrow. Hope diminishes.
This state of cognitive constriction is described as “tunnel thinking”, in which individuals lose the ability to perceive alternatives or imagine recovery.
Decisions made under such psychological conditions may appear incomprehensible to others, but feel inevitable to the person experiencing them.
Such deterioration often occurs quietly.
Men in distress often continue to fulfil daily responsibilities.
They go to work, attend social gatherings and interact politely with neighbours.
Outward functioning can mask profound internal struggle.
Families may notice subtle changes, such as withdrawal, irritability, loss of interest, sleep disruption or increased pessimism, but these signs are often easily attributed to stress or fatigue.
By the time a crisis becomes visible, opportunities for early intervention may already have been missed.
Meaningful changes needed
Men’s mental health is a public health priority.
Addressing this hidden crisis requires moving beyond awareness slogans towards meaningful structural change.
Help-seeking must be reframed.
Seeking psychological support should not be portrayed as a weakness, but as an act of responsibility, particularly for individuals carrying family and societal obligations.
Public messaging needs to speak directly to men in language that resonates with lived realities, rather than clinical terminology.
Mental health care must become more accessible within everyday environments.
Many men are more comfortable discussing distress with general practitioners (GPs), workplace health services, religious leaders or trusted community figures than within specialist psychiatric settings.
Integrating mental health screening and support into primary care and workplaces can enable earlier detection.
Recently, I met Maurizio Rosini, a Kuala Lumpur-based men’s coach who runs a group dedicated to supporting men’s mental health in Malaysia through workshops, retreats and “men’s circles”.
His group sessions focus on breaking the stigma of “man up” culture and promoting open discussion about mental struggles to combat male isolation and suicide.
Unfortunately, for now, the traction for such groups remains confined to urban populations.
Families also require a greater understanding of how distress manifests in men.
Persistent withdrawal, expressions of hopelessness, escalating anger or sudden behavioural change should prompt concern rather than dismissal.
Emotional suffering rarely announces itself dramatically; it often whispers before it shouts.
Start with the boys
Emotional literacy – the ability to recognise, understand and communicate feelings – should be cultivated from childhood.
Boys must learn that vulnerability does not negate strength.
Teaching emotional regulation, conflict resolution and help-seeking skills equips future adults with psychological tools that reduce the risk of crisis later in life.
None of this implies that mental illness excuses harmful behaviour.
Accountability remains essential.
However, prevention depends on understanding pathways, not merely condemning outcomes.
Societies that ignore emotional suffering until catastrophe occurs will continue to respond only after irreversible loss.
The reality is that many men around us may be struggling quietly.
They fulfil expectations, meet responsibilities and maintain appearances while carrying fears about finances, relationships, ageing or personal adequacy that they feel unable to share.
If there is one lesson to be drawn from recurring national tragedies, it is that psychological suffering does not always look dramatic or disruptive.
Sometimes, it exists behind politeness, routine and silence.
The absence of visible distress should not be mistaken for well-being.
Creating safer families and communities therefore, requires more than crisis response.
It requires a cultural shift, one that allows men to speak openly about vulnerability without shame, to seek help without fear of judgement, and to recognise that emotional struggle is part of being human rather than evidence of failure.
A society that gives men permission to ask for help may ultimately prevent suffering that would otherwise remain hidden until it is too late.
Understanding men’s mental health is not about assigning blame.
It is about recognising risk early, supporting resilience and ensuring that silence never becomes the most dangerous coping strategy of all.
Datuk Dr Andrew Mohanraj is a consultant psychiatrist and the Malaysian Mental Health Association president. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
