Throughout high school, Alexander Sanchez was severely depressed. He thought about suicide, and he didn't know how to explain what was wrong or ask for help. Instead, Sanchez said that whenever he wasn't in school, he would lie in bed all day, "not eating, not being happy, being almost not there."
It wasn't until Sanchez, who grew up in College Station, Texas, got to college that a friend convinced him to see a psychologist, who diagnosed him with depression. In hindsight, Sanchez said he did not reach out for help sooner because he believed that men should be self-reliant— an idea he believes he picked up from Tom Cruise and other macho characters on TV and in movies.
"I think I had really internalized this emotional stoicism that I know I was supposed to have," said Sanchez, 21, who is now a senior studying psychology at New York University.
Mental health has become a crisis among America's youth, and experts say the unique challenges and needs of young men are not receiving enough attention. Doctors, teachers and family members may not recognize the symptoms of depression, which in men can include anger, irritability and aggressiveness, according to the National Institute of Mental Health. Men are also less likely than women to "recognize, talk about and seek treatment" for depression, which is sometimes stereotyped as a women's problem, the agency said.
While teenage girls attempt suicide more often than teenage boys, according to the American Foundation for Suicide Prevention, boys are more likely to die by suicide. Suicide rates for teenage boys and girls rose steadily from 2007 to 2015. In 2015, there were 1,537 suicides documented for boys ages 15 to 19 and 524 for girls, according for the Centers for Disease Control and Prevention.
Boys see seeking help as "a sign of weakness," said Dennis Barbour, president of the Partnership for Male Youth, a group of organizations that focus on the health of young men.
Compounding the issue, almost half of adolescents with mental health issues don't receive care, according to a2016 report from the federal Substance Abuse and Mental Health Services Administration. The report, which looked at data from 17,000 adolescents ages 12 to 17, also found that girls were more likely than boys to receive mental health care in both schools and medical settings.
Around puberty, girls typically begin to see a gynecologist, who may spot mental health issues and refer them to other services, Barbour said. He said teenage boys tend to see doctors less frequently, particularly if they no longer see a pediatrician.
"In terms of depression, they don't usually have a place for health care," Barbour said of boys, "so that any depressive symptoms can be overlooked, even by parents."
Difficulty acknowledging depression
When Sanchez was in high school, his mother, Jennifer Sanchez, 46, a bookkeeper, suspected something was wrong, but she couldn't persuade him to talk to her about it.
"I'd sit there a lot," she recalled, "just hoping he'd let me know anything."
Sanchez said reaching out to adults, including his mother, was "complicated." "I didn't know how they would respond to something like mental health," he said.
He was also unwilling to acknowledge his own depression, which he described as "a rock that wouldn't move."
"All that I've noticed is that men are only supposed to have anger," he said, "but it really is kind of in direct contradiction to our nature as people."
A recent nationalsurvey commissioned by Plan International, a global network of organizations focused on ending poverty, polled over 1,000 youth ages 10 to 19 and found that a third of boys thought society expects them to "be a man" and "suck it up" when they feel sad or scared. Another third said they believed they should "hide or suppress their feelings when they feel sad or scared." About half of boys polled said "they want to learn more about having the 'right to feel any way you want.'"
After high school, Sanchez moved to New York to attend NYU. He suffered what he called a "major depressive episode" during his sophomore year, and saw a psychologist for the first time at the urging of a friend.
Sanchez said therapy helped him learn to identify difficult feelings, like hopelessness and guilt, and talk about them. He said he now speaks to his parents almost every day.
"Depression feels like a wave — everything is just completely clouding how you can articulate thoughts," Sanchez said. "Being able to think through what I'm feeling, talking to my parents, telling them really exactly what's going on, it's been good for our relationship, and for them to be able to help me better."
'They have to disconnect from the core part of who they are'
Depression is on the rise across the U.S., and it is climbing fastest among teens and young adults, according to data from health insurance federation Blue Cross Blue Shield, based on 41 million health records. In 2016, 2.6 percent of children ages 12 to 17 were diagnosed with major depression — a 63 percent increase from three years earlier. While it's not entirely clear why, some experts blame the rising influence of electronics and social media.
Social media plays a complicated role in the friendships of teenagers. According to the Pew Research Center, many American teens believe social media helps them feel more connected to friends, but six in 10 said most of their daily interactions with friends were online rather than in person. Forty-one percent said the main reason they didn't spend more face-to-face time with friends was that they had "too many other obligations."
Young men may be shouldering the brunt of the despair associated with a lack of close friendships, according to Niobe Way, a professor of applied psychology at NYU and author of "Deep Secrets: Boys' Friendships and the Crisis of Connection."
“To value relationships and emotional intimacy is to so-called ‘not be a boy’ or ‘not be a man.'"
Over 15 years, Way conducted hundreds of interviews with teenage boys across the U.S. She found that 85 percent wanted close friendships with other boys, but typically stop forming these relationships around puberty.
"To value relationships and emotional intimacy is to so-called 'not be a boy' or 'not be a man,' and so they have to disconnect from the core part of who they are," Way said.
Adam Neville's mother brought him to Mount Sinai's Adolescent Health Center in New York when he was 14 because he had difficulty communicating his emotions, with "unexplained outbursts of crying," he recalled.
Neville, now 16, said he didn't feel "at all" comfortable talking about his feelings with others, particularly his friends.
"With my counselor it's different because it's literally what that relationship is for," Neville said. "That's a little bit different, but in all of my personal life relationships, it's very difficult to ask for help, and the idea that I have to be or should be independent weighs on me constantly."
"If you can't turn to someone in your life and say how you are really feeling," the high schooler added, "then you're only going to end up hurting yourself somehow down the road."
A solution: connection
When young men don't get the help they need, the consequences can be devastating. Echoing the suicide pattern for boys and girls, men are about3.5 times more likely to die by suicide than women, though women are more likely to attempt suicide.
But Barbour said few guidelines exist in the U.S. to help parents, educators and clinicians understand young men's needs, so the Partnership for Male Youth is working to fill the void. The organization created aguide for health providers that details boys' unique needs around health, including how they may express mental health issues.
"The fact is that very little work has been done to develop practical solutions for young men and mental health issues, including depression," Barbour said.
One solution, according to Way, is for adults to encourage kids to connect — especially boys.
Way and her colleagues created "The Listening Project," which aims to build connections among seventh-graders in New York City's public schools.
Under the program, students are trained to interview their peers to "enhance listening, challenge stereotypes, build relationships, and foster a greater sense of humanity," according to a press release.
"As they're being trained, what I'm really doing is nurturing their natural capacities to connect," Way said, noting that America's education system typically doesn't foster these types of skills.
The program began in 2014 at George Jackson Academy, an all-boys school in New York, and has since expanded to six co-ed middle schools in the city, with two more joining in the spring. Teachers are trained to make the program a permanent part of their curriculums. Way hopes to bring the grant-funded effort to other states as well, but it's not yet clear when.
Sanchez, a student of Way's at NYU, said he no longer thinks "being a man" is about stoicism or self-reliance — noting that both men and women need to express their feelings and reach out to others to be mentally healthy.
"I think it's less about what it means to be a man," Sanchez reflected, "and more what it means to be human."
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.