I call depression in men a hidden epidemic. Epidemic in that depression afflicts millions of men in the U.S. alone. Hidden in that too many of those men will not get treated for depression. They may not even recognize that they have depression! That’s a great shame because depression is one of psychiatry’s great success stories.
Ninety percent of people who get treated for depression report substantial relief, but fewer than three out of five get the help they need. It seems that a man is as likely to ask for help with depression, than he is to ask for directions. And for much the same reasons: Men don’t ask for help. Period. That’s because it goes against the traditional male code – the code of invulnerability. What it means to be a man is to be invulnerable. The more invulnerable you are, the more manly you are. The more vulnerable you are – and particularly emotionally vulnerable – the less manly you are; you’re weak, a sissy.
Depression carries a double stigma when it comes to men. There is the stigma of having an emotional disorder that might challenge anyone. Beyond that, there is the stigma of unmanliness. It is not unwomanly for a woman to be depressed, but men aren’t supposed to get overwhelmed, particularly not by emotions, which is exactly what happens with depression. This double stigma sets off in many men what I call compound shame. These men are depressed about being depressed, ashamed of feeling ashamed. They’ve been set up to hide how they feel – and many do: to others certainly, but even to themselves.
Research shows that girls and women tend to internalize distress, ruminate about it and blame themselves. Boys and men, by contrast, tend to externalize distress – blaming others, or acting out their feelings through self-medication with substances or with processes, like gambling or sexual infidelity.
Depression is usually seen as a woman’s disease. Supposedly, depressed women outnumber men two or even three times over. I think that figure is off – for two reasons. The first is simple under reporting; men minimize their depression. The second reason is a little more complicated and a lot more impactful. As I mentioned earlier, some men do such a good job of hiding their depression that they hide it from themselves. These men have what I’ve called hidden or covert depression. In covert depression you don’t see signs of the depression per se, but rather signs of what the man is doing to escape his depression – drinking, drugging, taking high intensity risks, womanizing, workaholism. You see the depression’s footprints in the man’s life. I speak of an unholy triad in male depression:
- – Self medication
- – Acting out – either sexual or aggressive
- – Radical isolation.
If either you or a man you love has exhibited any one of these symptoms, then that may indicate an underlying depression. Am I saying that every alcoholic, every rager, has a core of unresolved depression? I am not. But I am saying that many do.
Signs of covert depression, like anger, often respond well to antidepressant medication.
Listen, you have the right to health in your family. If you are the depressed man, reach out and get help. Have the spine to move beyond the male code. And if you are the spouse or family of such a man, so long as it’s physically safe, stand up and insist on health for you and your children. “Hey look, if you wanted to live alone in a cave you could suffer like this. But you chose to have a family. We need you to do something about this. Even if you don’t, we do.”
Many of the depressed men I treat are what I call wife-mandated referrals. This is not a time to stand on ceremony and wait until he wants to do it for himself. If you need to, you book the appointment. If he won’t go to individual therapy drag him to a couple’s therapist. But one way or another get him in front of a mental health professional who can diagnose, talk to him about, and ultimately treat his condition. You all deserve that. It might also help to enlist the help of your partner’s general physician, other family members, or friends. You decide what’s best. But please do something. Depression, both overt and covert, can be treated and improved, and even cured – if the man gets help.
Terrence Real is a nationally recognized family therapist, author, and teacher. He is particularly known for his groundbreaking work on men and male psychology as well as his work on gender and couples; he has been in private practice for over twenty-five years. Terry has appeared often as the relationship expert for Good Morning America and ABC News. His work has been featured in numerous academic articles as well as media venues such as Oprah, 20/20, The Today Show, CNN, The New York Times, The Wall Street Journal, Psychology Today and many others.
In 1997 he published the national bestseller: I Don’t Want To Talk About It, the first book ever written on the topic of male depression. That was followed by How Can I Get Through To You? an exploration of the role of patriarchy in relationships and most recently, The New Rules of Marriage: What You Need to Know to Make Love Work, a practical guide for couples and couples therapists.
Terry founded The Relational Life Institute, in Arlington, Massachusetts, dedicated to working with the general population to help women reclaim their voices and men open their hearts. The Institute offers a training program which begins with an introductory level practicum as well as workshops and trainings throughout the US and Canada.
For more information on his work, please visit his website, www.terryreal.com.