When his family brought him, Trong was physically and mentally exhausted. In the beginning he reportedly avoided all eye contact and just sat with his arms crossed, repeatedly saying “I am fine” whenever Tung asked him about his mental state.

But after being repeatedly reassured he was in a safe space, he let down his guard and began recounting what he had gone through in the past year.

Tung said the man had suffered a double blow 12 months earlier, losing his job and a whopping VND1 billion ($38,000) in the stock market. But he had kept his losses a secret from everyone.

Everyday he would put on his work clothes and leave at the usual time, but instead of heading to office, he spent the day in parks or on the streets, roaming aimlessly until nightfall.

When his wife asked for money for their living expenses, he maxed out his credit cards to keep up the facade.”The patient described clinical symptoms such as chronic insomnia and anxiety about his debts,” Tung says. “The contrast between reality and his pretend life gradually pushed him over the edge.”

Dr Nguyen Viet Chung at Hospital E’s mental health department received a similar patient. His patient, Dat, a 37-year-old small business owner, initially sought medical help for heart palpitations and breathing difficulties. Despite normal cardiology test results, further assessment revealed a mental-health crisis.

Chung says Dat had a ritual every morning: he would lock himself in the bathroom and slap his face to stay awake after sleepless nights.

While his shop’s revenues were declining and his bank loans were piling up, he never mentioned anything to his wife. When asked about his fatigue, Dat always reassured his worried family that everything was fine.

“The patient was in a constant high-alert state and also experienced generalized anxiety disorder”, Chung says.

His panic attacks were triggered by the sustained effort to suppress financial stress in order to preserve his identity as the family breadwinner, the doctor says.

It is almost culturally universal for masculinity to be associated with silent tolerance. Chung points out that boys are taught from a very young age not to cry because it is “unmanly” or talk about their feelings because “only the weak complain”.

These gender stereotypes gradually develop into toxic masculinity, which hails emotional repression as strength and frowns upon any vulnerability.

There are serious consequences to this. Statistics from the Worldwide Health Organization reveal there are 850,000 deaths by suicide around the world annually, and depression is the most common cause.

Notably, while women are reportedly more likely to be diagnosed with depression, men have a significantly higher chance of committing suicide in what is a counterintuitive trend called “the gender paradox of suicide”.

This is believed to result from men’s reluctance to get clinically diagnosed, a behavior that persists up to the very last moment.

When they are backed into a corner with no chance of escaping the situation, men will resort to death. Some 15% of the Vietnamese population suffers from some form of mental disorders, and, alarmingly, depression and anxiety disorders account for a third of that share.

The need to be seen and heard is common among men, yet it is also usually repressed.

A 2022 survey by Read found that 27% of male respondents wished to talk to a specialist about their pressure relating to finance, work and family. But there was a big obstacle that prevented them from reaching out: the fear of being judged.

Tung says most men view themselves as “the backbone of their family” by default, which encourages them to grin and bear things rather than speak up.

While women easily vent through active communication and physiological manifestations such as tears, men often choose to bottle things up or release their pent-up emotions through alcohol and sports, which provide temporary and superficial relief, he says.

He believes that long-term emotional repression is a ticking bomb, which not only increases the severity of one’s depression and increases the possibility of suicide, but also leads to physiological problems and lower work competency.

These issues can trap patients in a vicious cycle of failure and self-blame. Many males are only admitted when their health declines perilously and requires long-term treatment, whereas with early intervention they might have gotten away with psychotherapy.

To begin their liberation from toxic masculinity, experts suggest men should redefine what strength means, encompassing both physical and emotional capabilities.

A strong person should be someone who can let himself feel things and address their emotions. Men should choose the person they find most reliable and start opening up in low-pressure contexts such as while cooking or watching TV, instead of setting up formal meetings.

As for the trustees, they need to listen without judgement and affirm the speaker’s feelings instead of rushing to give advice.

Small everyday interactions with that dynamic will slowly thaw the ice in which many men freeze their emotions and allow them to truly connect with themselves and others.