In this article, I would like to explore what I consider perhaps to be one of the most significant challenges facing us today—the issue of male depression. Do men get depressed? They certainly do, though you wouldn't think it, to listen to many of them. Because male depression is widespread, deeply misunderstood, and too often misdiagnosed, it is a topic that desperately needs our attention.
As I reflect on over 30 years of clinical experience, I am appalled at the realization that I have misdiagnosed male depression many times. Of course, it was not really my incompetence that was to blame. The truth is that there's been a "cover up."
For many decades, perhaps centuries, society has seen depression as a woman's condition. As a result, the symptoms of depression have become "feminized" and we have become indoctrinated with the idea that depression is a "woman's problem." We have become so accustomed to seeing how depression manifests itself in women that we are unwilling to diagnose men as depressive unless we see the same symptom pattern in them. It is no surprise, then, that many men, although deeply depressed, go untreated.
How to recognize male depression
The problem is that the symptoms of depression commonly seen in women are less common in men. Women are diagnosed mainly by exploring their feelings. Men are better diagnosed by paying attention to their behavior. Or, to put it more succinctly, women feel their depression; men act it! Women get sad and try to "connect" with friends or seek to take care of someone else—called the "tend and befriend" response—while men give vent to depression through frustration and anger. They become irritable and moody. They don't connect, but withdraw, retreating into their cave while they give their loved ones the "silent treatment." It is this "masking" of depression that characterizes male depression.
|"Changes in how a man expresses hostility and anger may be possible evidence for underlying depression."|
Let's look at a typical example that illustrates how men experience depression. Stan is an up-and-coming insurance broker. This past year, because of the slump in the economy, he is failing to make the sales goals that his superiors have set for him. When he gets the news that he will not receive his anticipated year-end bonus and is reprimanded and given a warning that his job may be on the line if he doesn't improve, he doesn't go home sad, tearful and grieving (which is what a healthy response to such a loss should be). He certainly doesn't seek out his wife to see if he can share his disappointment with her.
No, Stan barges in the front door, throws his briefcase across the floor and screams at the kids who are making too much noise for his liking. He heads for his recliner in front of the TV, reaches for the remote and tries to escape his problems. From previous experience, his wife knows that she had better not ask him how his day has gone. Nor is it an opportune time to tell him that the washing machine is making strange noises. And it is because Stan doesn't "connect" with his feelings of depression at this time that he exacerbates it—he creates a chain of further losses and alienation, called a "depression spiral." It may take weeks before he comes out of this spin.
On almost every radio program I have ever done on this topic, I have talked to at least one wife who can accurately describe the classic symptoms of male depression: "He becomes irritable, short-tempered, withdraws into a shell, refuses to talk. When he responds he overreacts—whether it be to the news, his dissatisfaction with his meal or the kid's noise." A lot of spousal abuse could have depression as the cause or trigger. Essentially, any change in how a man expresses hostility and anger needs to be looked at as possible evidence for an underlying depression.
How men mask depression
Masked depression is one of the most prevalent disorders in modern American society, yet it is perhaps the most neglected category in psychiatric literature. Our modern world is full of ways men can run away from their depressive pain and hide. The reason is that depression can be overt or covert. In overt depression, the symptoms include the traditional sadness, lethargy, negativity and mood changes. These are the hallmarks of classical depression—female, that is. For men, depression is usually more covert.
After all, we raise boys to be strong emotionally and not to be "sissies" who cry. It's not surprising, then, that when depression strikes the typical male, it doesn't connect so much at the feeling level, but at the behavioral. It is not that sad feelings aren't there. If you dig deep enough you will find them. Rather, these feelings are shoved out of the way by distracting behaviors, or numbed by some preoccupation. It is these distracting behaviors and preoccupations that "mask" male depression.
What are the common masks? I have space to discuss only four of them here, but they will help the reader get an understanding of what men do with depression.
1. Anger, rage and pent-up resentment
This mask is the dark side of male depression, and I have already alluded to it. It brings pain and hardship to a lot of loved ones who must live with a depressed male. It is obvious that as the incidence of depression has increased, mostly due to the increase in the stress of modern life, so has the incidence of male rage. Road rage, airplane rage, work rage, even rage on high school campuses (the Columbine syndrome) is everywhere.
I suspect that much of it has some depression as its root cause. Why do I say this? Because I have seen it in myself, for one thing. I have also seen it in many of my clients. Shortly after the Columbine shooting, it was discovered that at least one of the two young men was on an antidepressant. Workplace rage, in which a supervisor or colleague is killed, is always precipitated by a major loss, such as being fired. And the experience of loss is a major cause of psychological depression. When the depression is successfully treated, the rage and anger subsides. Men need help in dealing with loss in more effective ways.
Work can be a major distraction when it totally engrosses you. Here we have both a cause and effect for depression. Over-work, particularly when it is demanding (and what work isn't?) is the most significant cause of stress in our society. In some societies, people literally work themselves to death. The Japanese have a label for it—"Karoshi." We call it workaholism and have turned it into a respectable mask for men. But whatever the name, it still devastates the serotonin neurotransmitter system in the brain, causing depression. But work not only causes depression, it also serves as a mask for depression.
3. Avoidance of intimacy
The last thing a depressed male wants to do is "connect" in any intimate way. Sex, for the typical male, is not necessarily an expression of intimacy, so sex is not always excluded. The depressed male becomes cold and indifferent to his wife, family and friends. He withdraws and clams up. If this isn't bad enough, he takes it one step further and begins to search his environment for reasons for his down feelings (he hardly ever calls it "depression"), and this could result in a lot of fault-finding and blaming his immediate family.
4. Sexual compulsions
If there is one biological and psychological mechanism with the power to relieve depression's pain, at least temporarily, it is sex. Except in severe depression, most melancholic men don't totally lose their desire for sex. Observing many of my male clients, I have come to the opinion that many of those obsessed with sex are so because sex provides them with some pleasurable relief from their low mood—it becomes a way for the male to medicate himself.
Stress as a cause of depression
I cannot cover all the causes of depression here, but Christian leaders will find that some understanding of the causes of depression will be helpful as they try to help others overcome it. Earlier I mentioned that a significant 1 loss in a person's life can cause depression. The more significant the loss, the greater the depression. This form of depression is called "reactive depression" and is a form of grief. Usually, medication is not of any help, and the man needs to be helped in the grieving process. Getting fired from a job can be just as devastating to a man as the death of a parent or close friend.
Genetic factors can also cause depression. Here we see severe depression in several members of the same family. Fortunately, this form of depression is probably the easiest to treat, since antidepressant medications are specifically designed to counteract the effects of the gene on the brain's neurotransmitters or chemical messengers. Hormonal and thyroid problems (common in women) can also cause depression. Something called the "serotonin/ depression dance" explains why women get depressed whenever their estrogen levels drop (each month, after childbirth and with the onset of menopause). The drop in serotonin causes depression. Here, too, antidepressants can work wonders.
But these causes don't explain the epidemic of male depression we are now seeing. The only explanation is that stress is the culprit, and in some respects stress will also exacerbate female depression.
|"Our modern world is full of ways men can run away from their depressive pain and hide."|
How does stress cause depression? The stress hormones, called "glucocorticoids," are the culprits, especially one called "cortisol." It targets at least two areas of the brain: the synapses, where it reduces the number of neurotransmitter receptors, and the hippocampus, where it disturbs the brain's capacity to renew its cells. That's the bad news about stress. The good news is that the condition is reversible by lowering your stress and, if necessary, by using the same antidepressants that are effective in genetic forms of depression. However, when combined with psychotherapy, you have the greatest chance of beating it! And don't forget the need many depressed men have for spiritual guidance as well. Depression can make it feel that God is far removed from you.
So my message is clear here. We have to help men become more aware of when they are depressed and encourage them to seek the appropriate help. Men typically don't seek help. They see depression as a sign of weakness. But their cowardice in not dealing with their depression is the real weakness!
Living with a depressed man
It is unfortunate that many depressed men, including those who are Christian, refuse to go for treatment. Some who seek treatment don't respond satisfactorily. And even when treatment is successful, a depressed male can still be very difficult to live with! Wives, mothers and daughters of depressed men need all the help they can get to pull themselves through such difficult times.
Why is it so much more difficult living with a depressed man than with a depressed woman? Husbands of depressed women can at least escape in their work or retreat to a hobby or golf course. Wives of depressed husbands have nowhere to hide. Many quit their jobs just to take care of their husbands. Also, men are the ones who are supposed to be strong, not weak, and wives often struggle with this "reversal" of strength and dependence, finding that the adjustment is not easy for them to make. They "hate" having to be strong for both of them!
Depressed men also frustrate and alienate those they love the most. It's almost as if they have a need to blame someone for their depression, and the one who loves them the most is the easiest to target. So the more you love your husband, son or father, the greater is the potential that he will hurt you. Those who glibly say; "Don't take it so personally" don't really understand what's going on. It's easier said than done.
What is the most important thing a woman can do for the depressed male in her life? Without a doubt it is to communicate love and acceptance with all the power she can muster. It may take a supernatural intervention, she needs to rely on God for the grace and patience that will be needed. It is helpful to emphasize to her loved one that he has not intentionally chosen to be depressed. There may be a few rare exceptions, but most men would gladly give up their depression if they could. The women involved need to understand that the male's "bad" behavior is coming from his depression, not himself.
With God's help, unconditional love can make a difference in the long run to both partners and other family members. And even though he may never show any appreciation for this love at the time, the day will come when the wife or mother will look back with great satisfaction over how they handled the situation. For her, as with other challenges in her life, God's promise to Paul applies as well: "My grace is sufficient for you, for my power is made perfect in weakness" (2 Cor. 12:9).
For more help on how to deal with the depressed man in the life of a wife or mother, I refer you to my book Unmasking Male Depression, published by Word Publications (2001).
Archibald D. Hart is Senior Professor of Psychology and Dean Emeritus, Department of Clinical Psychology at Fuller Theological Seminary in Pasadena.