Mugabo, a 38-year-old man experienced trauma, watching his family members massacred during the 1994 Genocide against the Tutsi.

After spending five years in exile in DR Congo where he fled in 1994, he continued to bear the weight of these unresolved traumatic experiences.

Upon returning to Rwanda, he married due to an unplanned pregnancy. The relationship quickly became strained, as his wife frequently expressed dissatisfaction, complaining that he did not meet her expectations and often telling him that she did not like him.

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This emotional turmoil aggravated Mugabo’s existing trauma, leaving him feeling deeply tormented and unsupported.

For eight years, Mugabo suffered in silence, believing that expressing his pain would be seen as a weakness, as per cultural norms. He struggled with chronic headaches and back pain, eventually seeking medical help at King Faisal Hospital.

Despite thorough examinations, doctors found no medical cause for his symptoms. It was then suggested that he seek psychological help, marking the first time Mugabo opened up about his emotional struggles in 2022.

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Mugabo began a psychotherapy journey, during which he shared his traumatic experiences and worked with a therapist to understand and manage his symptoms.

This process led to significant improvements in his mental and physical health, as his headaches and back pain subsided, and he regained normal functioning.

Despite attempts to involve his wife in family therapy to strengthen their relationship, she was unwilling to participate and only attended one session.

In 2023, Mugabo and his wife divorced. He managed the stress associated with the divorce and continues to support their four children, who reside with their mother.

Across the globe, men often avoid getting help for their psychological issues.

According to the World Health Organization (WHO), men are less likely than women to seek help for mental health issues and are much more likely to commit suicide – men die by suicide at twice the rate of females.

WHO stated in 2021 that in Rwanda, suicide causes about 9.5 deaths per 100,000 persons per year, and men are at a higher risk with the ratio of men to women being 3:1.

Experts say that his discrepancy may partly stem from the greater reluctance among males to seek mental health treatment and internalized expectations around "masculine behavior.”

Why the reluctance to seek help

Dr Celestin Mutuyimana, a psychotherapist at Baho Smile Institute in Kimironko, highlights several cultural and natural factors that influence men’s hesitancy to seek help.

"Traditionally, men are seen as strong individuals who must find solutions to their problems independently. In many cultures, including Rwandan society, seeking help can be perceived as a sign of weakness,” he noted.

Dr Mutuyimana added that a common Rwandan proverb states, "A man’s tears fall inward”, loosely meaning that a man should not openly show his emotions. This belief triggers a reluctance to express emotions publicly.

He added that men often prefer to solve their problems privately, as they feel a sense of accomplishment and pride in overcoming challenges on their own.

Additionally, he highlighted that the issue of trust also plays a role as men may be hesitant to open up to others, fearing that their vulnerabilities could lead to a diminished perception of their abilities.

Another Rwandan proverb encapsulates this sentiment: "Umugabo arigira, yakwibura agapfa,” which roughly translates to, "A man should fend for himself, if he fails, he will die.” This proverb suggests that men should rely on themselves for solutions, even to the point of risking their well-being, Dr Mutuyimana stressed.

Jane Abatoni Gatete, the Executive Secretary of ARCT-RUHUKA, a national NGO of professional counselors, emphasises the pervasive stigma surrounding mental health issues.

She noted that despite the commonality of these problems, stigma remains a significant barrier, particularly among men. Globally, it is recognised that men’s mental health often goes overlooked and untreated due to the stigma associated with seeking help.

"This stigma is closely tied to sociocultural aspects, including traditional masculine norms and cultural influences that define acceptable behavior,” she added.

Gatete noted that cultural and social norms play a crucial role in shaping attitudes towards mental health, particularly for men. In many societies, including Rwanda, there is a strong cultural expectation that men should be stronger than women.

"This belief is instilled from a young age and reinforced by gender roles and power dynamics. Cultural proverbs like "A man doesn’t cry,” "men’s tears go to the stomach,” and "boys will always be boys” perpetuate the notion that men should not show vulnerability or express emotions. In contrast, women are often seen as more emotionally expressive and are culturally permitted to cry.”

Gatete explained that these cultural influences can have a profound negative impact on how mental health is perceived, particularly among men, stressing that the stigma attached to mental health issues often leads men to internalise public attitudes, resulting in feelings of embarrassment and shame.

Gatete explained that men experiencing mental health challenges may be viewed as weak, broken, or not "real men.” This stigma, she believes, can cause men to suppress their emotions to present as "manly” and "strong,” which is detrimental to their mental well-being.

She said, that suppressing emotions and avoiding to seek help can lead to challenges in coping, for instance, men may experience increased aggression and violence, depression, anxiety, substance abuse, suicidal ideation, and other health risks.

The fear of being judged or perceived as weak prevents many men from accessing the professional support they need, exacerbating their struggles.

Promoting mental health awareness among men

Dr Mutuyimana highlighted that it is crucial to help men become aware of their personalities and encourage them to seek support when needed.

He added that family members can play a pivotal role by showing empathy and actively listening to men’s struggles.

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"Breaking down cultural barriers and gently highlighting the benefits of maintaining mental health can be effective. Educating men about the consequences of neglecting mental health, the benefits of seeking help, and the available resources is essential.

Men should understand that mental health professionals possess specialised skills and knowledge beyond what they might have themselves,” Dr Mutuyimana said.

To support men in this journey, self-help strategies can be beneficial like physical exercise to improve mood and reduce stress.

He also mentioned that meditation and mindfulness can help men stay present and manage their emotions more effectively.

Mutuyimana urged men to join support groups, stressing that connecting with others who face similar challenges can provide valuable support and a sense of community, in addition to eating a balanced diet to contribute to overall well-being and positively impact mental health.