For many teenage boys growing up in South Africa’s urban townships, emotional distress is part of everyday life but rarely recognised as a mental health issue. New research suggests that pressure to appear strong, unemotional, and self reliant often leaves boys struggling in silence, even as anxiety, stress, and low mood shape their daily experiences. The findings were published in PLOS Mental Health.
The study focused on adolescent boys and young men living in Alexandra, a densely populated and economically disadvantaged area of Johannesburg. Researchers explored how boys understand mental health, how masculine expectations shape their thinking, and how they cope when life feels overwhelming. Rather than using clinical language, many boys described distress through familiar terms linked to pressure, overthinking, or feeling stuck.
Mental health was often seen as distant or irrelevant, especially when compared with immediate concerns such as poverty, school performance, family responsibility, and exposure to violence. Some participants struggled to separate emotional strain from what they viewed as normal life in their community. This blurred line made it harder to recognise when support might be needed.
Ideas about masculinity played a central role. Being a man was widely associated with toughness, control, and the ability to provide financially. Showing vulnerability was often seen as weakness, discouraging boys from expressing fear, sadness, or confusion. These expectations were felt early, with boys reporting strong pressure to succeed at school or in sport as a future means of supporting their families.
Despite this, the research also found signs of quiet resistance. Many boys questioned rigid masculine ideals and expressed personal beliefs that valued openness, emotional honesty, and talking to trusted adults or peers. This tension between dominant social norms and individual beliefs appeared to shape how boys navigated their mental health.
Coping strategies varied. Positive outlets such as sport, music, and creative activities helped some boys manage stress and regain a sense of control. Informal support from family members, mentors, or friends also played an important role, especially when trust and confidentiality were present. However, harmful coping methods were common too, with alcohol and drug use often described as ways to escape emotional pain, even though their effects were recognised as short lived.
Access to formal mental health support remained limited. Stigma was a major barrier, reinforced by beliefs that mental health care is only for extreme cases or not meant for Black communities. Confusion about where to seek help, combined with a lack of youth friendly services, further reduced engagement. In some cases, emotional distress was explained through spiritual or supernatural beliefs, which could delay or replace psychological support.
The findings highlight the importance of culturally grounded, gender sensitive mental health approaches. Support that builds on everyday language, familiar coping strategies, and trusted community spaces may be more effective than traditional clinic based models alone. Embedding mental health support within sports, schools, or youth programmes could help reduce stigma and encourage earlier help seeking.
By listening to how boys themselves describe their experiences, the research points to a need for mental health services that recognise both the social pressures shaping young lives and the desire among many boys for healthier ways of expressing what they feel.