William Styron, Mike Wallace, Art Buchwald, cultural luminaries
with one trait in common: All are prominent men who have publicly
revealed that they suffer from depression. Perhaps distinction or age, or
both, afforded them safety in disclosure.
That, however, is protection that most men lack. For them,
depression carries so much of a burden of shame that it is
hidden--sometimes so well it fools those who have it. It often
masquerades as drinking and lashing out at others, and subverts
relationships.
As a result, depression is vastly underdiagnosed in men, insists
Harvard psychologist William Pollack, Ph.D. When the true body count is
taken, depression may be as common among men as it is among women,
although current dogma holds that depression favors women two to
one.
Something happens to girls at adolescence to make them susceptible
to depression, many experts believe. Neurohormones such as estrogen,
genetic vulnerability, emotion-coping styles, socialization factors are
all implicated (see BB, July 2001).
Even so, Dr. Pollack and others contend, the culture goes to work
early on boys to suppress their real rate of suffering. "Boys are trained
in ways that make it likely they get depression later. If it doesn't
destroy their relationships sooner, it shows up by midlife. Midlife
crisis is a euphemism for male-based depression."
The problem is males and females express depression differently,
although no matter what triggers the disorder, in both genders it
eventually shows up in biological changes in the brain.
Even in 2001, says Dr. Pollack, associate clinical professor of
psychiatry, many boys are still brought up by a code. From the age or
three or four, whether from Homer Simpson or from home, boys learn a
series of injunctions: "Don't cry." "Stand on your own two feet." "When
you're most in need of help don't show it," because you should do it on
your own. "Don't show your need to be held." "Avoid anything feminine,"
which especially involves the expression and discussion of feelings, and
feelings of vulnerability in particular.
"We still do this, subtly and unconsciously," says Dr. Pollack. The
only feelings deemed acceptable for boys to display are anger and
frustration.
Boys who don't conform are ridiculed, called wimps and wusses. And
that dictates what they do when they feel sadness or pain. They suck it
up, don't reach out, and never talk about how they feel. What the boys
code forbids them to do is to show the signs of depression that women
do--weepiness and helplessness--at least in front of others.
Unfortunately, the diagnostic criteria for depression are almost
exclusively based on women's experience of the disorder--because they've
been the ones willing to present themselves as patients.
There are many men who experience the "classic" signs of
depression, too. But there is a difference even in them, observes family
therapist Terence Real, MSW, of the Family Institute of Cambridge. They
hide it. Their shame at having feelings inconsistent with the male role
silences them. They suffer a compound depression--on top of their
now-hidden depression they are depressed about feeling depressed.
Even more men exhibit what he calls covert depression. "You don't
see the depression itself but the defensive maneuvers men use to evade or
assuage it," says Real. Signs include:
• Self-medication. First and foremost is drinking, but also
abuse of other drugs.
• Risk-taking, including compulsive gambling, womanizing, and
acts of bravado that show up as high rates of accidental death. These are
"desperate acts" that both numb the pain and show the world "I'm a real
man" by denial of vulnerability. Says Dr. Pollack: "We see them as bad
boys rather than sad boys."
• Radical isolation. Men withdraw from relationships, from
their wives.
• Lashing out. This can run the gamut from increased
irritability to domestic violence, even homicide.
"Women internalize depression and tend to blame themselves," says
Real. "Men tend to externalize distress and blame others." They move into
action--and distraction.
Such defenses may protect them from feeling depressed but not from
being depressed. Real cites the example of author William Styron, who in
Darkness Visible described how his depression revealed itself only when
he stopped decades of heavy drinking. The depression was part of his
character for a long time, managed with self-medication. When the
self-medication stopped, the depression became visible.
The intoxicant defenses and lashing-out defenses, Real finds,
represent men's attempts to ward off the anguish of shame by inflating
their own value. In short, he says, they transmute shame into
grandiosity, what he calls "the central theme of masculinity." As he sees
it, the inclination to bravado takes permanent hold at adolescence.
Indeed, until then, boys and girls exhibit the same rates of
depression.
The mental health establishment recognizes that grief and other
forms of emotional pain in males may be expressed in acts as well as
words throughout childhood. Drinking, substance abuse, and antisocial
behavior are all cited in the psychiatric bible, the Diagnostic and
Statistical Manual of Mental Disorders (DSM IV), as signs of depression
among teens. But not among men.
