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.

Be Not Afraid

February is Black History Month and on February 1^st, Google had a caricature of Harriet Tubman with her lantern on their search page.  It was not a great caricature but it got me to thinking about her many midnight journeys and how much fear she had to overcome.  Harriet Tubman not only had to overcome her own fear to free herself from slavery; she had to overcome the fears of all the other slaves she went back to get.  She returned to the South 19 times and freed over 300 slaves.  She reportedly carried a gun and told those that got tired or afraid, “You’ll be free or die.” (http://www.pbs.org/wgbh/aia/part4/4p1535.html)

What if we told ourselves something similar to that?  What if we told ourselves, “You’ll be successful or die trying” or “You’ll be happy or die trying”?  What if we were not afraid to chase our dreams of freedom from monotony and mediocrity?  What if we were not afraid to go back and pull others out of the ghettos from which we came?  What would you do if you were not afraid of failure, disappointment, or simply looking stupid?  What would your life look like if you were not afraid to step out on faith and stretch yourself to live your purpose?  What would your life look like if you were not afraid to simply do something different to get a different result?  What would you do if you were not afraid?

If I were not afraid, I would probably speak my mind more; but like most people, I am afraid that I will be disliked or may lose friends because of what I might say.  If I were not afraid, I probably would have written more than one book by now; but it has taken so long to get over the fear of publishing this first one that I have been paralyzed.  If I were not afraid, I would be practicing full-time instead of part-time and trusting that all my bills would be paid.  Those are just to name a few of the big ones.

Because I am not afraid of being hurt, I have opened my heart to love again; I understand that hurt is a risk that will not kill me.  Because I am not afraid of my feelings, I regularly go to therapy to face them and process their meaning in my life.  Because I am not afraid of being judged as a bad parent, I have come to terms with the poor decisions my daughter has made in her life, despite all the lessons I tried to teach her, and am allowing her to work through the mess she created on her own.  Because I am not afraid to be myself 99% of the time, I can look in the mirror every day, without shame, and genuinely love who I see looking back at me.

Could I have done what Harriet Tubman did?  I can’t say because I didn’t live in those times.  I would love to think that I would have had that much fortitude and strength.  Like Tubman, though, I do refuse to let another human being break my spirit and I do refuse to let fear hold me back from what I know I deserve to have in my life. 

In the Bible, God says, “Be not afraid,” 366 times – an average of once every day of the year.  That is a commandment that I believe I need to follow daily.  My challenge to you is that you do the same: Stop being afraid, start doing things you have dreamed about, and see how your life changes.

2014 Vision

Welcome to 2014!  It’s hard to believe that we are already at the end of the first month.  So, how many of you have already given up on your New Year’s resolutions? LOL.  No worries.  Nobody’s judging you.  Most people are done with them within the first 30 days.  That’s why I choose not to make New Year’s resolutions.  Instead, I decide on things I want to try or things I want to do and set small goals for myself.  I also do a vision board; so I can see my vision for the year clearly.  So, what’s in store for 2014?

Overall, what I want for 2014 is true, genuine happiness.  In order to get that, though, I must create balance in my life.  I need to balance my mind, body, and spirit to make happiness become real for me.

To work on my mind, I stay in therapy and I read books.  I like going to therapy because it helps me clear my head, bounce things off another person, and learn things about myself.  If I didn’t have my therapist, Carla, I think I might just implode because I would have nowhere to put my “stuff.”  Just like my clients, I have “stuff” to deal with too.  For example, I get anxiety every time my editor talks about my speaking tour for my book.  I’ve luckily been able to process that in therapy to figure out what is really going there and how to deal with it.

To work on my body, I have added healthy living to my vision for 2014.  Now let me explain my definition of healthy living. My definition of healthy living includes healthy eating and exercise.  In my definition of healthy eating, you don’t have to give up anything unless you want to; but you must learn to eat the bad stuff in moderation.  So, I will still have my M&M’s; I just won’t eat the whole pack.  I still allow myself a beer; but it’s light beer and it’s only one.  Pizza is on thin crust, etc, etc.  You know, things like that.  In my definition of exercise, something is better than nothing.  That’s my only goal: to do something each day.  Whether I play a game on the Wii, do Zumba, or walk the stairs instead of using the elevator, I must do something physical every day to get my heart going.  Now, is that going to make me skinny overnight? No way!  It will, however, make me healthier; and I will build up to be able to do more as I get stronger and stronger.  The bottom line is: there is no beating up on myself allowed.  I can eat what I want in moderation.  I can move my fat butt or not – my choice – but I have to suffer the consequences if I don’t.  I am tired of suffering the consequences of being unhealthy and physically unfit: feeling tired all the time, short of breath coming up the stairs, not fitting in my clothes, but most of all, not feeling good about myself and how I look and feel. 

To work on my spirit, I am trying, for the third year, to read the entire Bible in one year.  So far, I have kept up with the daily readings.  More importantly, I am enjoying my daily readings and getting to know the Word of God again.  This is an important goal for me because my spirit really needs to be fed this year.  I took some hard hits in 2013 and was skating on thin ice.  So, I need to reinforce my foundation of faith as I face this New Year.

Getting my life balanced will balance me and with balance comes happiness.  What is happiness, you ask?  What does it look like?  What does it feel like?  Well, it’s subjective.  Your happiness is how you define it for yourself.  My happiness is a hot pink heart shape.  It smells like fresh baked chocolate chip cookies.  It tastes like good champagne with dark chocolate.  It sounds like a romantic whisper in my ear.  I can feel it, warm, in my chest.  It feels like a soft fuzzy blanket on my skin.  I see happiness every day in roses, puppies, babies, ocean waves, sunsets, at the beach, and in nature in general.  That’s what my happiness is to me.  It’s a tangible and reachable goal.  What’s your happiness?  Where can you find it?  How do you get it?  Then, once you get it, how do you keep it?

What is your vision for 2014?

Friends

The word friend comes from an Old English word meaning to love freely.  Merriam-Webster defines a “friend” as:

-        1. A person you like and enjoy being with

-        2. A person who helps or supports someone or something

-        3. One attached to another by affection or esteem

-        4. One that is not hostile

-        5. One that is of the same nation, party, or group

-        6. One that favors or promotes something

-        7. A favored companion

I define a friend as:

-        1. Someone who is ALWAYS there for you no matter what

-        2. A “ride or die” buddy

-        3. Someone who has your back at all costs

-        4. Someone who helps you pick up the pieces when life implodes around you

-        5. Someone with whom you can share anything and everything – the good, the bad, and the ugly

-        6. Someone who is there to help you, however he or she can, before you even ask

My definition of a friend comes from what I know I would do for a friend and what I would want a friend to do for me.  My therapist and I argued for half a session about how you define real friends and who they are in my life.  The sad truth is that in analyzing who actually meets my criteria, the list is very short.  What I came to realize is that I tend to be a much better “friend” to the people in my life than they are to me.

This sad revelation came as I was packing up my living room to move next week.  After working two jobs and being up since 4AM, I was in my living room all alone with no one to help me pack.  I hate moving as much as most people do; but I have helped people pack and move several times.  I just grit my teeth and get in there and do what I can.  Yet, when it comes time for me to move, there is no one to be found.  To their credit, I actually have some “friends” that were honest and just told me, point blank, “Don’t ask me to help you move because I’m not going to do it.”  Other “friends,” who always give lip service to “Anything you need, you know I am there for you,” are nowhere to be found either.  So, after I got my living room packed, I started to think.

I started to think about whether my friends are really my friends.  By Webster’s definition, I would say, “Yes.”  I enjoy being with them and I feel like we are attached by affection.  They are not hostile and I would consider most of them “a favored companion.”  By my definition, though, I am not sure that all my “friends” are truly “friends.”  It may be time to put a few of them in the “acquaintance” category.

As I sat amongst my boxes, I started thinking about other situations in which I may have needed help.  It is not easy for me to ask for help; but, I have learned how to do it.  Unfortunately, as I thought about more and more situations, I realized that I had gone through the storm pretty much by myself – with no one on whom to lean for whatever reason. 

Most of my “friends” are my age or older, only a few are in their 30s.  We ALL work and we are ALL driven.  Some have kids, some do not.  Some are married, some are not.  Seemingly, however, when I am in need, everyone is too busy to help.  Yet, whenever one of my “friends” needs help, I find the time or make the time to help them out.  I will schedule something on my off day.  I will reschedule clients if it’s something urgent or serious.  I will give the last dime that I can afford to give.  I will block time off my schedule to be there for a future event or need.  But, when it’s my turn, the effort is not nearly reciprocated.  That revelation wounded my heart.

So, my therapist believes that I should scrap everyone on the list who doesn’t meet my definition of “friend” – no matter how long they have been in my life.  She believes I should start fresh and make all new “friends.”  I don’t agree.  I believe you have to accept to people where they are and believe them when they show you who they are.  I think what I will have to do is start categorizing my “friends” into sub-groups, such as:

-        1. Those that are strictly acquaintances

-        2. Those that will always be there to talk ONLY

-        3. Those that I can call up for a spontaneous road trip

-       4.  Those that will actually be PRESENT to help me with whatever I need

-        5. Those that I can truly call FRIEND who will meet my needs the same way I will meet theirs

Then, I will have to learn to set boundaries with those that do not warrant all my time and effort.  I understand that going out of my way is my choice.  So, with someone that I know will never reciprocate that level of “friendship,” I will just have to start holding back.  That way my love tank doesn’t run empty – leaving nothing for my or those on whom I can depend.  That will take some self-evaluation and self-exploration on my part as well as some difficult decisions because I am naturally a “helper.”  Not giving my all is like trying to hold back the tide. LOL.  

I give myself permission, however, to set the necessary boundaries to take care of my heart and my needs.  I give myself permission to expect that the same level of friendship I give will be reciprocated to me.  I give myself permission to say, “No,” when I need to say it and to not feel guilty about it.  I applaud myself for being a good friend and I am grateful for the “friends” and acquaintances that I do have.

So, as always, I leave you with a challenge.  Take a good hard look at your “friends” and decide for yourself if you need to do some “housekeeping” in that department.  Is it time for you to re-categorize the people in your life?  Is it time to get rid of some dead weight?  Is it time to let some new people in?  Are you overlooking anyone in your life that could be a good friend if you would let them?  Just some things to think about.