Bipolar 1 Disorder in Men Is Underdiagnosed and Stigma Is Partly to Blame

For men, asking for help has long been framed as a failure. That framing, argues Kevin N. Williams, M.S., M.P.A.S., PA-C, is not just culturally damaging. It is clinically costly. As CEO and lead clinician at OnPoint Behavioral Health, Williams sees every day what happens when men internalize their struggles instead of addressing them, and the consequences rarely remain contained to the individual. They ripple outward into relationships, families and communities in ways that are often invisible until the damage is already done.

This Men's Health Month, Williams is making the case that mental health belongs in the same conversation as prostate screenings and cardiovascular risk, not as an afterthought but as an equal priority. Drawing on his experience as both a clinician and a father, he is sharing what silence actually costs men living with conditions like bipolar 1 disorder, how to spot the warning signs that are easy to miss or misattribute, and why reframing treatment not as weakness but as an act of strength and self-awareness may be the most important shift in men's health today.

Men are statistically less likely to seek mental health treatment than women, so from your perspective as both a clinician and a father, what does that silence actually cost men and the families and communities that depend on them?

Kevin N. Williams, M.S., M.P.A.S., PA-C: When it comes to speaking up about mental health, silence costs more than people realize. For men, who are often less likely than women to speak openly about their mental health, silence can affect every part of life, such as their relationships, their home dynamics, their work and the communities that rely on them. Many men experiencing symptoms of mental illness do so quietly because they’ve been conditioned to believe that asking for help is a weakness, rather than embracing that acknowledgment as a strength.

As a clinician, I see the internalization of mental health concerns manifest through a variety of behaviors, including irritability, frustration, anger, insomnia, increased substance use or social withdrawal. As a father, I also think about the ripple effect of mental health and how it can impact not only the individual, but also their family and broader community.

Social conditioning tells men that seeking help is a sign of weakness, but you work with patients navigating serious mental illness, including bipolar 1 disorder. How do you reframe that narrative in the exam room in a way that actually resonates with male patients who have spent a lifetime being told to tough it out?

KW: In the exam room, it is critical that each visit feels like a conversation rather than an interrogation. Oftentimes, when men walk through my door, especially early in treatment, they are still testing the waters to see if they can trust me. Through dialogue, not lecture, I aim to create a safe space where patients can feel comfortable opening up, knowing they will not receive judgment from me.

A lot of men have a desire to appear strong, and they feel as though seeing someone for their mental health means they are, or seem, weak. One of my goals is to help them reframe asking for help as a sign of strength. That starts with trust, so the conversation can reveal what is really going on.

Strategies like motivational interviewing are key. Together, we can explore how someone’s behaviors and goals are aligned. Many of the men I work with share their goals of being present for their family, stable in their relationships, able to perform to their standards at work or overall feel more in control of their lives. Once we identify the objectives, we can talk about how what he is experiencing is helping him move closer or further away from achieving them.

Bipolar 1 disorder is a condition that demands accurate diagnosis and thoughtful treatment for stabilization of mind and mood. Those foundations can then empower someone to build relationships, engage with others or improve their self-confidence. I see how a patient might begin their mental health journey feeling that treatment equates with weakness and, over time, come to believe there is strength in the self-awareness needed to have the conversation, to understand their experience and to take the next step toward wellness.

Bipolar 1 disorder is often misdiagnosed or goes undiagnosed for years, and the stigma around mental illness in men can make that gap even wider. What are the warning signs that men and their loved ones should know that might signal it is time to seek a formal evaluation?

KW: That is a hard question because the indicators of a possible bipolar 1 diagnosis can vary from person to person and be challenging to identify, especially in men. If it was as simple as one or two easily observed clinical markers, more men would already be receiving treatment. For family members who aren’t attuned to a medical checklist, I invite them at any point in their loved one’s care journey to pay attention to significant shifts in mood, behavior or functioning that no longer match his typical way of acting or being.

Patterns worth noting include sleeping much more or less, changes in relationships or decision-making, substance use, anger, irritability, anxiety or agitation. Shifts that initially seem simple or purely physical, such as disrupted sleep or elevated blood pressure, may open the door to a bigger conversation about underlying mental health concerns. In my experience, loved ones are often the first to notice when something doesn’t seem right and often before their family member is ready to say it out loud.

Clinicians familiar with bipolar 1 disorder will also know that the symptoms that bring people to their office tend to cluster around depression, and there may be more to the story. Specifically, patients tend to come in complaining more about their depressive symptoms than their manic symptoms. I commonly hear that depression feels more disruptive and problematic, whereas their own perception of mania or hypomania may be more neutral or positive. Because depression and bipolar disorder are treated differently, part of the evaluation is asking, “What condition is sitting in front of me?” Loved ones can be a help here if they can share insight into their family member’s emotional swings over time.

Men's Health Month is typically associated with physical health screenings like prostate cancer and cardiovascular risk, so why is it equally, if not more, important to use this month to start conversations about mental health and psychiatric conditions?

KW: Men’s Health Month should include the whole person because a man’s physical health and his mental health are often intertwined and deserve equal prioritization. I think the opportunity, especially during an awareness month like this one, is to empower men to become more aware of and comfortable with the topic of mental health so they can be more proactive rather than reactive about seeking help. Too often, people are in a state of crisis before they address what they are feeling or experiencing. Receiving help before that point of escalation also relates to one of my key clinical desires, which is to help people stay at a consistent level of wellness even while living with a complicated, lifelong condition.

Mental health is part of being healthy. Men’s Health Month gives clinicians, families and loved ones an opening to say, “Let’s talk about all of it,” including the mind, the mood, the body and all that a man may be privately carrying.

What do you teach future generations of psychiatric clinicians about working with male patients who are resistant to treatment, and how can receiving care, including medication, be reframed as an act of strength and leadership rather than a sign of vulnerability?

KW: When I teach future clinicians, I emphasize that educated, experienced perspectives, shaped by emotional intelligence, are critical to understanding the needs and motivations of the patients in front of them. With male patients, especially those who are resistant to treatment, you cannot walk into the room assuming they are going to open up just because they made the appointment. Whether it’s their first or 50th appointment, you can’t presume to know what they’re feeling as they walk into the room.

In my opinion, the clinician’s first responsibility is to create a space where men can communicate openly and not feel judged. As mentioned before, I am a big advocate of motivational interviewing as a tactic to reveal how behaviors and goals are matching up.

I am intentional about how I reframe the conversation around care, including medication. It is not about weakness. It is being self-aware enough to say, “This is what I am experiencing, and I want to do something about it.” For some patients, medication is part of what allows for stabilization of mind and mood, better engagement with others and better self-confidence. In the treatment of bipolar 1 disorder, medication is considered the standard of care alongside therapeutic support.

We have to be purposeful in how we prescribe. Medication planning is highly particular to the person, and the conversation has to include their concerns about side effects, tolerability and quality of life. When patients understand why a treatment is being recommended, what the goal is and what to watch for, they are more likely to feel like we are making the decision together from a place of informed strength.