Depression in Men
By Nancy Small, Ph.D.
The roster includes some very influential, creative and accomplished men throughout history Abraham Lincoln, Winston Churchill, William Young, Vincent Foster, Mike Wallace, and William Styron. You might not realize this, but your husbands, fathers, brothers, and male friends may also share something in common with this illustrious group. What could that be?
The shared legacy of these men is compellingly spelled out in William Styron's memoir, Darkness Visible, which tells the story of this Pulitzer prize winning author's experience of profound and suicidal depression a state whereby "nothing animates the body or spirit. It's a total wipeout." Styron even went so far as to confide to his daughter that he would rather "undergo an amputation" than experience another depression in which he felt "condemned" to life. Mike Wallace endured the "endless darkness" of three episodes of crippling depression before he sought professional help, referring to those periods of his life in which "sunshine means nothing to you at all. The seasons, friends, good food mean nothing. All you focus on is yourself and how bad you feel."
Depression in men is infrequently talked about. Typically, it is seen as a woman's illness that rarely affects men. Unfortunately, the culture supports the myth that real men don't get depressed, seeing this very real disorder as weakness, laziness or perhaps labeling it "stress." Even the medical profession is less likely to diagnose depression in men than in women; Mike Wallace's doctor, for example told him there was nothing wrong with him at the time of his most desperate state. Against this background, both Styron and Wallace, in publicly talking about their ordeal, helped break the conspiracy of silence around this disorder. As many as one in eight men experience depression during their lives; yet, only a small proportion of them seek out professional help. And for every man suffering the most severe, biological forms of depression, similar to Styron and Wallace, there are at least four who may be wreaking havoc in their families through less severe states of this illness.
The men in your lives may also be silently suffering from this illness, and it is important that you be alert to some of the signs and symptoms which might signal its presence. As women and caretakers, we are often on the front lines, sounding the alarm when something is amiss in our families. And, as much as we may think we can recognize depression in ourselves or others, men often do present differently than women when they are depressed. Whereas women tend to feel pain, men typically get into trouble and cause pain around them, creating problems with family members and co-workers.
The classic signs of a biological depression, which often runs in families, include the following: Sleep disturbances (interrupted sleep or oversleeping), appetite disturbances (no appetite or overeating), lack of concentration, anxiety, irritability, fatigue, lack of interest in usual activities, and most significantly, suicidal thoughts and acts. Men, however, show more covert signs of depression: becoming angry, irritable, self-medicating through alcohol and drug abuse, having affairs, withdrawing and acting irresponsibly.
Terence Real, a psychotherapist and author of the book, "I Don't Want t Talk About It: Overcoming the Secret Legacy of Male Depression," identifies these symptoms as the Unholy Triad of covert depression, grouping them as follows: 1) self-medicating to enliven dead feelings by drinking, drugging, womanizing, overworking, overeating and overspending. 2) radical isolation: pulling away from relationships, intimacy, life itself. 3) lashing out, from increased irritability to domestic abuse and violence. Finally, men make more serious and violent suicide attempts, very often quite successfully (slitting wrists, hanging self, driving off a cliff).
Men do not usually directly seek therapy for depression. Instead, they come into treatment for a myriad of other problems: business difficulties, career dissatisfaction, marital distress, and sexual affairs. One man I treated, despondent over some business failures, completely withdrew from family life at the height of his depression, retreating to a beach house where he was unavailable to family members. His wife subsequently divorced him and there has been a cutoff with his children, all of which could have been prevented if he had recognized and sought treatment for his illness at an earlier point. Another male, a devoted family man, came to see me with pangs of guilt over an affair he was having in the office. In exploring the real basis for his unhappiness, it was revealed that he had not found pleasure in his career as a lawyer. With a short course of medication and continued therapy, he was able to address and resolve the source of his distress, choosing to change careers for a more satisfying life style.
Treatment is available both through psychotherapy and medication. The milder forms of depression might be amenable to individual or couples therapy alone, but the more severe states with biological markers typically require the added benefit of psychopharmacology. There are many medications available that have been shown to resolve the more pronounced symptoms of depression, originally heralded in by Prozac, (e.g., Lexaparo, Effexor, Wellbutrin). There is an 80% cure rate for depression, which is significant, and there continue to be advances in the field, both with psychopharmacology and alternative approaches.
Although medication might ameliorate the most disturbing symptoms, it is important to tackle the stressors that either precipitated the depression or those behaviors that maintain it. A positive family environment and a healthy response to stress have been shown to have an inoculating effect against depression, even with those having a biological predisposition to depression. In therapy, we explore the patterns of a man's life and intervene in those areas which have been self-destructive or maladaptive. We strongly encourage men to give up those addictive and aggressive behaviors that typically mask the real pain. However, it is not always realistic to get men to express these underlying feelings given the societal constraints they have grown up with, and often the feelings only follow when behavior changes are made. Towards this end, men are encouraged to move actively into a relationship mode, reducing their isolation and getting them more involved with their children, wives, etc.. They are also pushed to take better care of themselves through developing healthy habits (e.g., exercise, nutrition, relaxation) over a lifetime.
Women, be alert for signs of depression in your men. Don't forget that lack of interest in sex is a common feature. Make them aware of the help that is readily available. It could make a huge difference in your lives as well. Depression accounts for considerable family instability (alcoholism, workaholism, lack of communication, angry outbursts, emotional and physical abuse), and in addition to saving a life, it could also save the life of your marriage and family. Please, if your husband refuses to come in for himself, ask him to join you in marital sessions to address the issues in your relationship which invariably accompany depression. And, certainly reassure him of your love and continued support, essential components of any healing process.