What is IMS?
What are they saying about Jed's new book?
Bring your Irritable Male back to life
Why Male Depression Is Hidden: My Personal Experience
In my marriage, I would often get irritable, angry, blaming, and judgmental. I was sure other people, particularly my wife, were doing things that caused me to become irritable and angry. I couldn't see that the source of the problem was inside. Usually the irritability and anger that is characteristic of the "acting out" variety of the Irritable Male Syndrome (IMS) is obvious, though its cause may not be.
There's another side of the problem that is usually hidden. I describe it as "acting in" IMS. Here our irritability may cover a more severe, yet concealed, problem. For many men, chronic irritability is a symptom of depression. Yet because the classic symptoms of depression don't include components of irritability, it is often missed in men.
This was the case with me. One of the times I noticed it was after our son was born. Although I was ecstatic at his birth, I also felt irritable and edgy. I knew that some women suffered from post-natal depression, but I didn't think it could occur in men. No one did 34 years ago when my son was born.
However, recent studies in England suggest that men also have problems after the birth of their children. Mary Alabaster, the manager of maternal mental health services has developed a program that includes men. Her own research suggests that male postnatal depression exists and is triggered by a wide variety of causes. "It really has to be taken seriously," she says. "There has been lots of research that shows that fathers actually do suffer from postnatal depression, but people aren't actually doing anything about it."[i]
There have been a number of times in my life I had been concerned that my irritability and anger might be related to depression. As a professional therapist I was well aware of the official symptom list, and periodically I would go over them to see how they applied to me.
Here is how it is determined if a person is suffering from depression using the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the main diagnostic reference of Mental Health professionals in the United States of America:[ii]
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
Note: In children and adolescents, can be irritable mood.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- (9) Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Every time I checked my own feelings and behavior against the criteria for depression listed here, I concluded I was not depressed. I rarely experienced depressed moods as the official manual defined them. I didn't feel sad or empty or appear tearful. I didn't feel a markedly diminished interest or pleasure in all, or almost all, activities. I noted that irritable mood is only an indication of depression in children and adolescents.
I always felt like a guy returning from the dentist. I was relieved that they didn't find any cavities, but concerned that they hadn't found a cause for my pain and discomfort. However, when the symptom was irritability, it seemed I knew the cause. The cause, I firmly believed, was my wife, or sometimes my children, friends, colleagues, the President of the United States (with his irrational policies), or "this messed up world we have to live in." If there was a problem, it was clearly their problem. Getting my wife into treatment might help things, I thought. But, I was firmly convinced, my irritability and unhappiness didn't have anything to do with me.
Whenever my wife, or occasionally a close friend, suggested I might want to "see someone," I could easily brush them off. "Look, I'm a mental health professional. I've been in practice for more than 30 years. Don't you think I would know if I had a problem? And listen, don't take my word for it. Here, look at this." I'd remind her that that I wasn't depressed according to the professionally accepted official manual. I didn't qualify. Case closed.
It took me a long time to believe that there might be something going on with me despite what the official manual said. It took even longer for me to wonder if the official manual might be wrong. As a psychotherapist I saw a lot of people who were depressed, primarily women. The criteria in the DSM-IV seemed to fit the majority of the depressed women I was seeing. However, though it fit some of the men, it seemed to miss a lot of those who I believed were depressed.
Furthermore, I couldn't understand why the DSM-IV would recognize that irritability was a symptom in children and adolescence, but fail to recognize it in adults. For me irritability was one of the prime emotions that I was experiencing and my unhappiness generally expressed itself through worry, anxiety, and hypersensitivity.
I also remember my work over the years with people suffering from substance abuse problems. We used to believe that heroin addicts "got well" if they survived to be 40. That was because we didn't see them showing up in treatment programs after that age. The problem was that they were showing up in alcohol treatment programs. Since the two types of programs didn't communicate well with each other, we often didn't notice that the spontaneous cures were anything but that. In fact, most of the addicts who had not fully recovered had simply switched to a different drug.
I wondered if a similar thing was happening with depressed men. In my work with men who used and abused alcohol and other drugs, I found a lot of them were depressed. However their depression was rarely recognized or treated because it was covered by their alcohol use. In some ways the men were "self medicating." Using alcohol was a way many depressed men dealt with their painful feelings.
[i] Adam Lusher and Brian Welsh. Men To Get Counselling for "PostNatal Depression." Accessed August 24, 2003 on the World Wide Web. www.telegraph.co.uk/news/exit.jhtml?exit=http://www.maledepression.com/
[ii] Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV). American Psychiatric Association, Washington D.C., 1994
Does this sound familiar? Drop me a line and let me know what you have experienced.
Sign up for Jed's exciting, informative, up-to-date men's health newsletter, and receive a FREE copy of Jed's booklet "Why Men Die Sooner and Live Sicker: And What You Can Do About It."
Sign me up!
This article first appeared on Gordon Clay's MenStuff Web site, http://www.menstuff.org/