For much of his adult life, John*, a busy executive, suffered from crushing depressions. “It makes physical pain look like a cakewalk, “ he says. “It dominates every moment of your existence. Not even a minute goes by that you don’t have a sense of profound sorrow.” But John did not discuss his depression with anyone, not even his wife. He states: “I’m part of the John Wayne generation. It’s only a ‘flesh wound’: that’s how you deal with it. I thought depression was a weakness - there was something disgraceful about it. A real man would just get over it.”
Instead, he became a workaholic, growing more and more remote from his wife and children. He plunged passionately into his business and one hobby after another. According to John: “It’s the ultimate way of doing work - all you do is focus all day because you can’t think much of anything else. It is just a wonderful way to take away thought.”
Sadly, this is a picture commonly seen by mental health professionals. Many men try to hide their condition, thinking it unmanly to act moody. And it works: studies suggest that doctors miss the diagnosis of depression in men a full 70% of the time. Another reason it stays hidden though, is that men tend to express depression differently to women. Research shows that women tend to internalize distress, while men externalize it. Depressed women are more likely to talk about their pain and reach out for help: men often have less tolerance for internal pain and turn to some action or substance for relief. Doctors are having to learn to look past their own bias. They tend to be more comfortable with a woman expressing emotional distress and so tend to look more to the emotional side for a diagnosis for women and more to the physical side for men.
In their attempt to escape pain, many men turn to overusing alcohol and drugs, working excessively or seeking extramarital affairs, or going into isolation, withdrawing from their loved ones. They may also lash out, becoming irritable and violent.
According to Dr Jean Endicott, a psychologist at the University of Columbia: “I’m convinced that we are missing a lot of depression in men. It’s often hard to diagnose depression with alcohol or drug abuse confusing the issue. Whether men drink and use drugs because they are depressed or are depressed because of the substance abuse is uncertain. But in either case, the depression itself needs treatment.”
Many researchers have suggested that a new list of criteria be drawn up for the diagnosis of depression in men, as the current criteria are too ‘feminised’. There is still a lot of debate in this area, but what is known is that men do tend to exhibit slightly different symptoms. Many think adding irritability to the criteria would be a good start. According to Dr Ron Kessler, a professor of health care policy at Harvard agrees: “When you study depression among children, they don’t talk about being sad, they talk about being angry and irritable. Children don’t have the cognitive capacity to make sense of all their feelings. There’s a great similarity between children and men. Men get irritable: women get depressed.”
Whatever the case though, it is important that men start coming forward for treatment. Although depression is often considered a ‘female disease’, since affected women reportedly outnumber men by four to one, male depression has been found to be more rampant than originally thought and the stats are climbing. Possibly because men are less likely to seek help and because they have a higher chance of having a substance abuse problem in conjunction with the depression, the disease seems to take a greater toll on them. They commit suicide at four times the rate that women do (although more women try it) and new studies suggest that depression increases men’s - but not women’s - risk of dying from heart disease, possibly due to the fact men tend become more aggressive and to develop workaholic tendencies to cope with their pain.
For more information, telephone counselling or referrals to various support groups and mental health professionals, the Depression and Anxiety Support Group can be contacted, Monday to Friday, between 8am and 7pm, and on Saturdays, between 8am and 5pm, on (011)783-1474/6.
According to Terence Real, co-director of the Gender Research Project at the Family Institute of Cambridge: “The causes of depression differ in men and women, as well. While depressed women often feel disempowered, depressed men feel disconnected, from their needs and from others. This begins in childhood, as society teaches boys early on to pull away from their mothers, their emotions and their vulnerabilities. Reconnection is the key. Treatment first requires resolving the violent or self-medicating behaviours - the affair, the drinking or the workaholism - so that the underlying condition can be grappled with.”
* names have been changed