Movember is the perfect time to talk about the stigma that continues to haunt mental illness among men. What, you may ask, is the connection between men’s mental health, cowboys, and moustaches? The answer is, as it turns out, a lot more than you think.

Big bushy lip-sweaters were as much a part of the old West as mesquite, tumbleweeds, buffalo, longhorn steers, painted ponies and the Colt Single Action Army 45, the archetypal six-gun of the American Frontier aka The Peacemaker, The Equalizer and The Hog Leg. And let’s not forget Judge Colt and his Jury of Six. No self-respecting lawman, cowboy or gunslinger would have been seen dead without a six-gun and a bristling handlebar moustache. Given the proliferation of firearms and the appropriate use of the adjective wild in the descriptor Wild West, they were frequently seen very dead indeed. Six-gun in hand. ‘Taches intact. Famous exponents of the signature Western handlebar muzzy include: Wyatt Earp, Judge Roy Bean, George Armstrong Custer, Pancho Villa, Emiliano Zapata and, buddies and arch mustachio rivals, Wild Bill Hickok and Buffalo Bill Cody. To name but a few. In the golden age of cowboys, along with bandanas, gloves, lariats and twelve-inch Bowie knives, mustachios were considered essential equipment.

The ability to grow a fine moustache in the heyday of the old West was seen as a badge of manhood. Among impressionable aspiring young cowboys the inability to grow so much as a patchy misplaced eyebrow is known to have triggered severe antisocial behaviour. It may be that a conspicuous lack of facial hair so enraged William H. Bonney, aka Billy the Kid, that he killed no less than eight men. (We don’t know if his victims had moustaches but there is evidence suggesting they may have shared a penchant for conspicuous upperlipholstery.) Billy was laid to rest, nude upper lip and all, by magnificently moustachioed Sheriff Pat Garret.

Having connected cowboys and moustaches, all that remains is to explain their relevance to the stigma that continues to shadow mental illness among men.

Many of us can look back on pretending to be cowboys when we were kids. Cowboys were all kinds of slow walkin’ slow talkin’ six-gun totin’ cool. They were paragons of toughness and silent endurance. Hence the origin of sayings like, “Cowboys don’t cry.” Well they jolly well should and they would live longer if they did.

The face under the brim of the sweat stained Stetson is very often sad. The tall, tough, suntanned drink of water coming through the swing doors of the saloon all dusty chaps, tooled gun belt, pearl handled pistols and jingling spurs is a myth.

The archetypal cowboy is a shocking ambassador for mental health for a host of reasons. In fact, it’s hard to imagine a worse candidate.

Your average cowboy was almost always one of a self-selected group of males attracted to a solitary life for reasons often questionable if not nefarious. In addition to being isolated and disconnected from family and support networks by distance or choice, they probably already had ASD, interpersonal problems, social anxiety and failed relationships, not to mention a natural proclivity for gun violence. Now imagine putting these troubled individuals way out under the lawless stars of the Chisholm Trail or into a bunk house crammed with a bunch of volatile similarly afflicted ne’er-do-wells. What could possibly go wrong? Add guns and liberal amounts of whiskey to this psychological pressure cooker where voicing your pain, or indeed any sign of weakness, carried a stigma so powerful it could actually prove fatal, and stand by for some serious rootin’ tootin’ and shootin’.

While we don’t see a lot of cowboys in our practice we routinely see their modern day analogues. Dr Mark Whittington consults with a steady stream of military people, police and firies suffering from mental illness – often exacerbated by addiction to drugs and alcohol. These people are all fellows of other self-selecting groups whose members, like the proverbial cowboy, are expected to be robust, psychologically resilient and mentally strong. They are expected to be “tough”. Toughness is the price of entry to their fellowship. It defines them. It is what they expect of themselves and of each other. Tragically it is also the driver of the stigma that keeps them silent when they could and should be talking about their problems. We really ought to know better by now but the truth remains; in today’s world cowboys still don’t cry. Which is why, in the worst cases, they still die, literally and often in circumstances where they could have been saved had they only spoken up.

30 years of consulting experience has revealed these metaphorical cowboys are at high risk of burnout, often simply because they don’t know their limits. They keep pushing down on that metaphorical accelerator. They push themselves beyond breaking point. They dig deeper, try harder and ignore the warning signs. They turn a blind eye to that inner metaphorical red light warning them that a breakdown is imminent. The stigma of being perceived as weak keeps them silent. All too often until it is too late.

People in “cowboy” jobs require self-discipline and the ability to control and suppress both their emotional needs and their natural reactions to trauma. As a consequence, these men (and women) tune out to their inner selves, often to the point of becoming emotionally unavailable to their partners. When cowboys get together with other cowboys they often entrench toxic stereotypes often by deriding and laughing at those who were recently among them but who fell over and are now stigmatised as weak. Subconsciously all these individuals share the fear that the same thing could happen to them. And they fear the accompanying stigma even more! These are good, strong men. However, this does not necessarily make them supportive partners or good fathers. These well-meaning but misguided men teach their boys that it is their lot in life to be tough. “Be a man!” and “Man up!” are their toxic catch cries. As long as we men teach our sons that “cowboys don’t cry” and continue to exhort them to “man up”, the stigma will continue to be passed on to poison one generation after the next.

The status quo has to go. We men cannot continue to think that talking about our emotional problems, exposes weakness and makes us vulnerable. Our sons deserve better. They deserve better role models. The strong silent type doesn’t cut it anymore. They never did. The mortal enemy of a more humane and more reasonable approach to men’s mental health is stigma. And the enemy dwells deep within us where it can’t be easily reached by mental health education or the latest “are you ok?” advertising campaign. As men we have a responsibility to our children, loved ones and to each other. We have to shift the paradigm. And the only way to do that is to take ownership of our real weakness; our addiction to keeping up a front  that makes us appear strong at all costs. This has to change. Expressing emotions is a weak spot for many of us. And we all need to work towards changing this. We need to learn to tune in rather than out. We need to express not suppress. Because when we don’t we implode. There is nothing virtuous or admirable about suffering in silence. Like cancer, silence kills.

Cowboys still don’t cry. But they should. The sooner metaphorical cowboys learn to cry long and loud the happier they will be. And the longer some of them will live. None of us are bullet proof. Only cowboy tears can once and for all wash away the stigma that continues to stain the subject of mental illness among men. Like ten-gallon hats and six-shooters, the stigma is a fading artefact of a bygone more ignorant era. But it’s not fading fast enough. This Movember let’s consign the stigma to the pages of history where it belongs among the sad, lonely, homicidal moustachioed cowpokes and gunslingers of old.