After months of obsessive preparation for fatherhood, I brought my wife to her breaking point within a single day of our first son arriving home, an experience I recently detailed in Slate. The months that followed were a fog that’s familiar to many new parents, but despite my baby-book reading and spreadsheeting, I found myself unprepared for the specific malaise that hovered over me as a first-time father. That caused deeper problems at home.

This story is familiar to Justin Lioi. He is a clinical social worker and psychotherapist based in New York, and many of his clients are new dads dealing with acute anxiety or worse. He’s a father, too, and he understands better than most how issues with mental health and depression can be particularly tricky among men conditioned to bottle up their feelings, which is why he keeps a “Help My Partner” portal on his website. In my essay, he helped me pin down exactly what I was feeling and also why some new dads never reckon with their complicated reactions to having kids, leading to more problems down the line. Lioi had a lot of useful insight, so I’m publishing the full interview here, which has been condensed and edited for clarity.

Aymann Ismail: What do you hear from new dads when they come in for a session with you?

Justin Lioi: There’s a lot of anxiety. They want to be dads differently than they were parented, or than they saw their fathers doing: being more involved, being more present. And they didn’t have the model for that. So they are nervous: “How can I do this? If it wasn’t done for me, how am I going to do it?” And often for a lot of guys that I work with, they have very little experience with babies. We often talk about the different kind of learning curve, just from traditional social stuff here in that many girls, when they’re younger, take care of their siblings and are encouraged to babysit as they get older and stuff like that. And for a lot of the guys that I work with, the first time they hold a baby is right after their child is born. So they’re starting at this different place and they’re trying to kind of catch up. And they just have a lot of anxiety around that.

A recent study examined postpartum depression among men, which I’d never really considered before I had my son. It concluded that some of these cases were more dangerous because feelings of inadequacy and helplessness often turned into rage and anger.

I’m not surprised by that study at all. A lot of time when we’re looking at depression in men, it doesn’t look like what we see on TV, like someone who is really sad and can’t get out of bed. For a lot of men, it comes out as anger, comes out like high irritation or avoidance. That anger could be yelling, it could be banging tables. I get a lot of calls from guys who suddenly are like, “I didn’t think I was an angry person, and then I found I’d hit the table,” or “I banged the counter. Where did that come from?” And so we kind of delve into what is underneath that anger, which is often fear and anxiety and sadness and “What the hell did I get myself into? Can I do this? Would a good father—would a good man—want to get away all the time?” There’s also substances that get used in a way to avoid dealing with the really scary, uncomfortable feelings that they don’t want to have. They want to embrace this whole thing of being a dad and having a kid, and acknowledging that it’s not all happy and easy is something a lot of people fear because we don’t see that as reflected as much, especially for guys.

These men feel very isolated, and they don’t have many people to talk to about this. One of the first things I do is encourage people to talk to others, either dad friends or someone you can find that they could be honest with. Or to find those dads groups that are on Facebook or on the playground to have people be really honest with each other, so you’re not feeling so isolated.

My baby was born in June. I had some intense moments of panic. I’m not a quiet person, but I think I’m realizing now that I withdraw when I’m frustrated. When I felt that, I’d put on my noise-canceling headphones and do something else, or leave entirely. I did reach out to other new dads to see how they handled the hardest days of fatherhood so far, but not a single dad would say anything negative, which I found really interesting. They would instead share tips, and how much fun they are having. I suspect this has to do with wanting to bottle the burden rather than inflict it on your partner or others. Do you encounter this in your sessions?

Yes, definitely. Eighty percent of the guys that come to me are coming to me because a woman in their life found my profile and said, “You need to go talk to someone.” So they are at the point where just hiding it and swallowing it is not working anymore. And someone is sometimes even giving an ultimatum, like, “You need to do this, or I don’t know how we move forward.” So a lot of people come in already past a point from where you’re talking about. It makes them a little more willing to go to that place because they’re afraid of what’s about to be lost. Just think of some traditional—some would say toxic—ways that we are socialized as men: We are supposed to fix everything. We’re not supposed to be able to ask for help. It’s sad that a lot of your friends weren’t able to go there with you, but it’s not necessarily surprising.

I mean, a lot of stuff that I talk about with guys is when they’re talking to a female partner and they’re giving advice and she just wants to vent and not have him try to find solutions. Sometimes one of the things that they come to therapy for—I’m not saying, “And now you need to do X, Y, and Z.” They’ll get to the end of the session and be like, “Oh, you didn’t tell me what to do. And I feel better just being able to talk about that without someone telling me that.” I hear a lot: “I’m afraid I’m going to screw this kid up. What do I know? I don’t know how to do this.” And no matter how many books you read or blogs you read, it’s not the same as sitting there at 3 a.m. with your kid that won’t stop crying and vomiting and god knows what else.

I’ve found one of the more challenging parts of this for me is to identify whether or not I’m “depressed” or whether I need to seek help. The fact that 80 percent of your patients have been pushed to seek help is concerning. Even in having this conversation with you, I’m looking for those signs in my experience and it’s not so obvious. I feel happy. I think my son is perfect. I think my wife is perfect. We make it work. But I do have moments where I feel helpless or that I’m the one screwing everything up. It’s come to tears and dark moments. Am I the kind of person who should be looking for professional help?

So a couple of things in that. One of the most difficult things for all of us—and we certainly discovered it during the pandemic, if we didn’t know it before—is sitting with the uncertainty of anything . So when a child is crying and you’ve done all the things that you normally do—does he need to be changed, does he need to eat, is something too tight?—when you’ve done all that, sitting with that baby crying is one of the most difficult, horrendous things to do because you want to fix it. And number two, you’re seeing this thing that you brought into the world who’s really upset and you can’t do anything about it. And that helplessness is something we do not get a lot of practice at having. And recognizing that can be upsetting, because it’s not fixing it.

So, when to seek help? There are specific criteria for depression, for anxiety, for postpartum. How I work is less based on “Are we going to get this right diagnosis because you need help?” so much as “Are there things in your life that a bulk of the time are just causing you overstress or pain and getting in the way of enjoying being a dad, enjoying work, doing other things?” So whether we’re going to ever label that depression or not, we’re going to look at patterns in your life. We’re going to figure out the ones that are working and keep those. And the ones that aren’t, we find some new ones. So I suggest seeking support earlier than when it gets to a dangerous point. We can do some stuff to prevent things getting out of control in some more comfortable ways. But I mean, if someone who loves you is saying, “I think you could use some support, whether that’s therapy or whatever,” I would look into it, even if it’s just to talk to the therapist on the phone and see, “Do you think that I need this? Is this too much?” Part of our hoping to break down mental health stigma, especially for guys, is that just going somewhere and talking about some stuff is not meaning I’m sick, doesn’t mean I’m mentally ill. It just means I could use some better coping skills at the moment.

I get very nervous with people who say that “it’s all going great”—you just have to push through it. Again, “it’s all wonderful and roses and everything,” that sounds like a big denial because I think we all know that raising a child is not that at all.

What do you think I can do to help model a different path for my son? You said this question is one you get a lot, and that’s a big anxiety I have.

We start gendering kids from the point that they’re conceived. We’re forming pictures in our heads about how we’ll treat them, what games we’ll play with them, what they’ll wear, and all that stuff. I mean, some of it’s not even necessarily under our control. So kids are born into this world, boys or girls, with lots of expectations, no matter how good we are at saying, “I have no expectations. I just want them to be happy.”

Around somewhere between ages 8 and 10 and 11, I think, Terry Real talks about how we get halved in a way. Up until then, boys are very expressive and allowed to be expressive of all their feelings for a while, more so than girls, studies have shown. But at around 8 or 9 or 10, we can start getting the messages like “don’t cry, be a leader, hold this in,” and stuff like that. And girls are getting the opposite message: “Don’t be bossy, but be social, take care of each other,” and all that stuff. So these are two separate messages that we don’t allow any of our kids to be fully the human beings that they can be. So they start inhibiting certain parts of them. What you’re saying with boys, continuing to let them cry when they need to cry, continuing to let them say that they’re scared, continuing to show them that it’s OK to ask for help—both parents can do this by modeling that.

I have a lot of parents that will say to me, “I don’t want to cry in front of my kids” or “I don’t want us—me and my partner or my wife or husband—to argue in front of the kids.” And what happens with that is then your kids don’t learn how to be sad if they don’t see you cry or see you be sad. They don’t learn how to be angry in a healthy way if they don’t see you and your partner work things out when you get angry. It shouldn’t get out of control. They don’t want kids to think, “My parents are over the top.” But if we don’t model how to move through conflict and not use power in negative ways—how to use power in authoritative ways, not authoritarian ways—that’s just giving silent messages that lead to the toxic stuff. So it’s really in the modeling and what we are open to.

I’ll ask a lot of people I work with if they ever saw their father cry. And they’ll say, “It was once, at a funeral,” or something like that. “And it was really uncomfortable.” It shouldn’t be. I mean, I don’t think we need to be crying all the time, but this idea that “Oh, when Dad cries, I can’t handle it because it’s so uncomfortable.” That is just giving a message that crying, especially for men, is uncomfortable. Having a scared feeling to cry is not something that a man should have. And these are all things we need to model differently as adults, even though they’re uncomfortable.