b'ing stigma-free

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 fewerBarbells 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.

Compound Shame

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.

Covert Depression

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.

Get Help

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.

Terry RealTerrence 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.

iFred Sunflowers


Stigma…simply writing the word and reflecting on it brings many other descriptive words to mind: isolation, discrimination, shame, fear, to name just a few. It silences people during times when they need the most care, the most love, and treatment for their health. In relationship to suicide, it is life threatening.

Suicides are happening across the world every 40 seconds and many individuals contemplating suicide experience anxiety, depression and hopelessness according to the World Health Organization’s report Preventing suicide: A global imperative. The stigma that surrounds mental illness, coupled with symptoms of hopelessness, only isolate people more. Individuals with suicidal ideation often see no other way out of their pain.

Most illnesses that affect the body are treated with care and compassion. And yet, when illness affects our brain, we cannot talk about it. Individuals are left with a sense of shame or guilt, and led to believe there is something wrong with them for not being able to simply “feel better.”

Depression is treatable. By destigmatizing mental illness, we encourage individuals to receive the necessary support and treatment, thus saving lives. As communities we can offer compassion, discussion, education, and research on best treatment practices. Prevention programs may be offered, follow-up care provided, and families who have lost loved ones by suicide may be given a safe outlet to share their grief.

One way to end stigma is by rebranding the disease. By only displaying negative images of a person in the midst of a depressive state, society does not get to see the success of treatment and recovery. Positive and hopeful images will help people talk openly, build awareness, and break down the stigma barrier. Breast cancer eradicated stigma by primarily doing three things: focusing on the biology of a woman’s body, involving celebrities and leaders, and using a universal symbol for the disease.

If people’s perception of depression and mental illness may be changed to reflect a positive and hopeful outlook, we will help millions of people, prevent suicide, and promote living a life of positive mental health and well-being.


Kathryn GoetzkeKathryn Goetzke is the entrepreneur and innovator behind Mood-lites™.  The product line was made available nationwide at Lowe’s Home Improvement stores and was associated with the first successful cause marketing campaign for depression. She runs a consulting business and is the CEO of The Mood Factory, which just launched a new sensory line of products based on how smells impact moods. Kathryn was a featured presenter at Scent World, 2014 and her work has been showcased in Entrepreneur Magazine, Home, Chicago Tribune, BBC, CBS Chicago, InStyle, and more.

In addition, Goetzke is the founder of iFred (the International Foundation for Research and Education on Depression), dedicated to encouraging research on depression and reducing the stigma associated with the disease. The organization advocates to rebrand depression by utilizing the sunflower and color yellow as a positive universal symbol for depression; educating the public on brain biology; and inviting other organizations around the world to join in their efforts by planting sunflowers. Hopelessness is the number one predictor[i] to suicide, so iFred’s Schools for Hope program teaches kids about hope; this is based on research that hope is a teachable skill that can prevent suicide and promotes the importance of mental health.    

Kathryn serves on the Global Mental Health Advisory Board, and has presented on the need to rebrand depression around the world for NGOs and nonprofits. She recently participated for the third time in the World Health Organization’s invitation-only event, working on implementation of the Global Mental Health Action Plan adopted by the UN’s 66th World Health Assembly.

Kathryn is also on the Steering Committee of FundamentalSDG, a group of diverse experts in the field of global mental health. When FundamentalSDG noticed that mental health was not a part of the Post Millennium Development Goals they called for the United Nations to take action and make mental health a post-2015 sustainable development target. #FundamentalSDG invites you to add your name or organization’s logo to the site, tweet your support, and write to the United Nations on the provided template so leaders include mental health in the Post Millennium Development Goals.

[i] Sher, L., Preventing Suicide, QJM (2004) 97 (10): 677-680


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