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Men and Depression

Jed: One Man's Story


This article first appeared on McMan's Depression and Bipolar Web, and is reprinted here with the kind permission of the site owner, John McManamy

Jed Diamond, a therapist and author of Male Menopause, and his wife Carlin both took depression tests as part of a drug treatment program involving their son. Jed's wife scored high on the test while he scored low. As a result, Carlin sought and received help for her depression while Jed lived in a hellish fool's paradise of believing there was nothing wrong with him.

Years later, in response to Carlin's persistent suggestions that he, too, may be suffering from depression, Jed kept insisting, "I'm not depressed, damn it, leave me alone," clinging to his score from that depression test as "proof" that he was okay.

But all was not well.  As Jed describes it: 

"I was irritable and angry all the time. But there were reasons for that. I had a lot of stresses on my job, raising kids was not easy, and my wife was going through menopause and having her own problems. 'Who wouldn't be angry,' I would bellow to anyone who would listen."

Carlin received the brunt of his anger, which she fought to deflect. But what did she expect? Jed thought She kept doing all these things that irritated him. If she'd just be nicer, more loving, more interested in sex, everything would be okay. It never occurred to him that his constant anger made it nearly impossible for her to be nicer, more loving, more interested in sex.

"I was worried most of the time," Jed reports. "But wasn't that normal? After all I had to worry about making enough money to pay the bills. I had to worry about losing my job in an economy where someone else got rich while most of us got poorer and poorer. I worried about the children, grown and gone, but still needing help. I worried about my aging parents. I worried about the state of the world. I worried about getting old. I worried that I worried so much."

It failed to dawn on Jed that his worry was a symptom of an inner problem, not a response to problems which someone else was causing in his life. It never occurred to him that his irritability, anger, and blame were symptoms of a a type of depression psychiatry is only beginning to wake up to. "My insistence that I wasn't depressed," he finally acknowledged, "nearly ended my marriage and came close to ending my life."

Do men actually manifest depression differently than women?  Consider Neal Conan's intro to NPR's Talk of the Nation, which in late October of 2002 aired a show on male depression:

"There are many theories about men and depression. Some researchers argue that men experience depression differently than women. Men are more likely to describe depression as feeling burnt out, for example, rather than excessive sadness. And men are more likely to deny or forget feelings of depression. Some therapists also say that male depression is accompanied by drug and alcohol abuse and other self-destructive behaviors, like gambling, and that some men behave more aggressively, which can manifest itself as wife beating or child abuse."

According to Neal Conan's main guest, William Pollack PhD, a psychologist at Harvard's Medical School and the director of the Centers for Men and Young Men at McLean Hospital, and author of Real Boys: Rescuing Our Sons from the Myths of Boyhood: "A lot of men get angry, irritable, mean, impulsive, and we say they're ... SOBs and they're a pain, and let's get rid of them, let's fire them, let's divorce them, when, in fact, behind that mask of masculinity is actually the same sadness, hurt and pain expressed in a male-based fashion.

Says Jed: "We are missing millions of men who suffer from depression because we are not asking the right questions."

The DSM-IV's first and perhaps most important symptom for major depression is "depressed mood most of the day," and its only example is the unfortunate one of "appears tearful."

Skipping down to symptom three, we find: "Significant weight loss when not dieting or weight gain." Think of who runs to the fridge for Ben and Jerry's when feeling low, and now reflect on what men go to the fridge for.

Then we come to symptom seven, "feelings of worthlessness or inappropriate guilt." The male equivalent is probably closer to Dr Pollack's irritable and angry SOBs. Interestingly enough, Jed points out that irritability is listed as an example of depressed mood for youth depression, but is unaccountably absent for adult depression.

The ninth and final symptom concerns suicidality: More men commit suicide, and they may or may not think about suicide as often as women, but because women make far more attempts, they are much more likely to come to the attention of the psychiatric profession.

Lest we get tempted to split depression into Hamlet and Ophelia subtypes, we need to be reminded that many men suffer from "female" symptoms and vice versa. It is far more useful, instead, to think of depression as a beast of many faces, ranging from feeling sad to being anxious to expressing anger to out-of-character aggression. It is an illness that engages all processes of the mind and body, from not being able to think straight to throwing our eating and sleeping out of whack to setting us up for cardiac failure. It is more an illness of not being our usual self than simply being depressed, and hopefully one day the name will reflect that fact.

Unfortunately, psychiatry ghettoizes men, all too often tagging the ones who seek help as antisocial or substance abusers, and shunting them off to treatment that may not be appropriate or at best only a partial answer. The American Psychiatric Association is expected to issue a new edition of the DSM in 2010. Fortunately, thanks to an emerging awareness among therapists and psychiatrists, it appears likely that male depression will get a full airing.

As for Jed:

"Fortunately, I listened to my wife's entreaties that I get help. Too many men die, never realizing they are depressed, never recognizing they have a treatable illness. If you're one of those men, don't wait as long as I did. Your decision may be a matter of life and death."

This article first appeared on McMan's Depression and Bipolar Web, and is reprinted here with the kind permission of the site owner, John McManamy

McMan's Depression and Bipolar Web represents the web's most comprehensive one-person site devoted to depression and bipolar disorder (also known as manic depression), with more than 240 articles, more than 150 links, and news - from diagnosis and treatment to personal stories and essays to issues that touch all our lives.

This website also includes a reader's forum, an online depression and bipolar book store, and community message boards and chat.


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