Men and Depression

According to the World Health Organization, by 2020, depression will be the leading cause of disability (Watkins, Green, Rivers, & Rowell, 2006).  The American Psychological Association defines depression as extreme feelings of sadness or despair that last for two weeks or longer and interfere with daily functioning.  These feelings may lead to hopelessness and thoughts of suicide.  That definition is great for a clinical diagnosis.  However, depression does not look the same in everyone and it certainly presents differently in men and women.

While women will be openly tearful and talk about their feelings, men will not.  Women will eagerly seek help from a therapist; most men will not.  Honestly, there are many times that men’s symptoms get overlooked as a physical illness or simply a character flaw.  Sometimes, the only two people who ever even see the symptoms of male depression are their significant other and maybe their primary care physician.  That’s why it’s important to know whether you are seeing signs of depression in yourself or your man.

For men, symptoms of depression include the typical loss of interest in pleasurable activities, feeling sad, irritable, or angry, and maybe even thoughts of suicide.  However, the rest of their symptoms may not seem like depression when they really are.  According to Marc Bain, as cited in Scelfo (2007), these include:

• talking very negatively or being excessively critical
• acting recklessly or without concern for others 
• abusing alcohol or drugs 
•  behaving violently and/or picking fights 
•  withdrawing from family/friends 
•  losing interest in work or school 
•  talking suddenly about separation or divorce 
•  losing the ability to concentrate 
•  eating too much or too little 
•  sleeping too much or too  little

Again, these behaviors can be overlooked as “Oh, that’s just how he is” when a man is really struggling with depression.  And because he won’t talk about it, no one will know unless someone is paying attention.  Our society has embedded an idea of what a man is in our brains and the acceptable definition does not include “depressed.”  A successful man is upbeat, strong, and in control.  Even Tony Soprano portrayed the “strong, silent type” to his therapist (Scelfo, 2007).

Men’s experience of depression is much different than women’s experience.  For example, men are less likely to cry, overeat, self soothe, talk about it, or seek help.  They are more likely to withdraw, abuse substances, and act out risky behaviors (Wilhelm, 2007).  Because men’s experience of depression can be so different than the standard diagnostic criteria, they may not even know how to label what they are feeling.  Not knowing how they feel can lead to feelings of fear, vulnerability, weakness, and loss of control.  These are not feelings that men like to feel or will readily admit to, much less talk about.  So, they are left to repress their depressive feelings and hope they will simply go away.  Unfortunately, this buildup of emotions, or emotional repression, can lead to physical illnesses such as sudden cardiac death, hypertension, and heart disease - which is the leading cause of death in men (CDC, 2010).

Wilhelm (2007) offers “The Big Build” model to explain what happens to men the more they repress their feelings of depression.  The continuum builds up like this:

• Avoiding it – avoidant behavior (e.g., over involvement in work)
• Numbing it – self-medicating (e.g., withdrawal, watching TV) 
• Escaping it – escape behavior (e.g., drug and alcohol abuse, sexual affairs) 
• Hating me, hurting you – feelings of aggression towards self and others (e.g., increase in intensity or frequency of angry outbursts, rage, or violence) 
• Stepping over the line – deliberate self-harm (e.g., suicidal ideation or attempt)

So, what can women do to help?  First of all, women must pay attention to the signs and symptoms they see in their significant other.  Once depression is suspected, the biggest thing we can do is to be respectful of a man’s feelings – not just his feelings of depression but the feelings of fear and vulnerability that come along with that.  Understand that men do not want to be seen as weak or out of control.  You will want to reassure him that you see him as strong, or stronger, for confronting his feelings and getting help.  Encourage him to open up and talk about what he is feeling, either with you, with his doctor, or with a therapist.  Most importantly, do not ever laugh at, joke about, or use his feelings against him.  In fact, you need to be a safe space for him to put his feelings out where he will not be judged, discounted, dethroned, or emasculated.  Finally, be patient with him, understanding that he will have to process his feelings in his own way and in his own time.  You cannot “fix” this for him [as much as I know you want to].  All you can do is love and support him through the storm and applaud him once he makes it to the brighter side.

References

Centers for Disease Control and Prevention. (2010). Leading causes of death in males. Retrieved from http://www.cdc.gov/men/lcod/2010/LCODrace_ethnicityMen2010.pdf

Scelfo, J. (2007, February 26). Men and depression. Newsweek, 43-49.

Watkins, D.C., Green, B. L., Rivers, B.M. & Rowell, K. L. (2006). Depression and black men: Implications for future research. The Journal of Men’s Health & Gender, 3(3), 227-235. doi:10.1016/j.jmhg.2006.02.005-Watkins_etal2006.pdf

Wilhelm, K. A. (2009). Men and depression. Australian Family Physician, 38(3), 102-106.