Live Long and Well

Depression Unmasked: His and Hers

I think of male depression as being masked. Those of us who live with depression wear a mask that hides what we are really feeling from others and even from ourselves. People don't know we are depressed because what they see doesn't look like the kind of depression they are familiar with. We also mask our depression with other things like anger, alcohol, and chronic withdrawal.

As a result, the common view is that depression is predominantly a female problem. We think of teenage girls who are sullen and sobbing. We picture young women who become depressed after the birth of a child. We hear about mothers who are overwhelmed by the stresses of keeping a house and raising children (and now increasingly having to work). We read about the "empty nest" syndrome and know of women whose lives lose meaning after their children leave home.

Studies show widespread male depression

We don't usually associate the idea of "male" with the idea of "depression." Male and aggression, yes. Male and depression, no. This view that depression is more common in women is borne out by a number of major research studies. Susan Nolen-Hoeksema, author of Sex Differences in Depression, found that depression is about twice as common in women as in men.[i] "One of the most consistent findings in the epidemiological study of mood disorders over the past 50 years in the United States," say Drs. Sam V. Cochran and Fredric E. Rabinowitz, authors of Men and Depression: Clinical and Empirical Perspectives, "is that women suffer from depression at approximately twice the rate of men."[ii]

Similar results were found in two large-scale studies, the Epidemiological Catchment Area study (ECAS) and the National Comorbidity Survey (NCS). Both these studies are noteworthy in that they interviewed people in the general population rather than surveying people who are already in treatment. The ECAS was sponsored in part by the National Institute of Mental Health and used trained interviewers to survey samples from five population centers (New Haven, Connecticut; Baltimore, Maryland, Raleigh-Durham, North Carolina; St. Louis, Missouri, and Los Angeles, California. A total of 19,182 persons were interviewed).[iii]

The study reported lifetime prevalence estimates of psychiatric disorders by gender. For the affective disorders as a whole (Depression, bipolar disorders, dysthymia) women outnumbered men two to one. Interestingly though, men outnumbered women five to one in alcohol abuse and dependence and antisocial personality disorders. I will return to this point shortly.

The NCS was designed, in part, to minimize gender bias in the reporting of symptoms of mental disorders, including depression. This study sampled a total of 8,098 men and women between the ages of 15 and 54. Although considerably more females than males reported symptoms of depression, the ratio was 1.6 to 1 rather than 2 to 1.[iv] It was believed that more men reported symptoms of depression because the interviews were done in such a way to counteract the male tendency to forget or underreport symptoms. However, neither study looked at the possibility that the symptoms of male depression may be quite different than those for women.

Findings of more female depression may be biased

Although the generally accepted view is that women are much more likely to be depressed than men, these findings may be biased in the following ways:

• Different behavior of reporting symptoms. Men tend to be less in touch with feelings than women and less likely to discuss feelings when asked. In addition we often view being "down" as being "unmanly" and hence less likely to discuss these kinds of feelings.
• Since men don't seek professional help as often as women, there tends to be a bias that women are more likely to be depressed.
• Problems that are more common in men such as alcohol dependence, personality disorders, or acting out may mask depression.
• When depressed, women often ruminate and re-play situations and feelings in their minds. Hence they are more likely to remember and be able to report them. Men tend to project their feelings on to others and avoid or deny problems. They are, therefore, much less likely to describe themselves as depressed.
• Male role conditioning is such that we see ourselves as independent. If there are problems we are action oriented and solve them ourselves. We don't focus on our feelings or share them with others. Women are conditioned more towards sharing what is going on inside them whether or not there is a solution.
• Finally, symptoms that characterize female depression may be quite different from symptoms of male depression.

Male depression is different

Just as there are two life forces in the natural world, the outer-directed dynamic and the inner directed magnetic, I believe there are dynamic depressions which are expressed by "acting out" our inner turmoil and magnetic depressions which are expressed by "acting in" our pain. Men are more likely to experience dynamic depressions and women are more likely to experience magnetic depressions.

Women often express their depression by blaming themselves. Men often express their depression by blaming others-their wives, bosses, the economy, the government-Anyone or anything, but themselves. [v]

I have developed a chart to describe the main differences in the ways males and females experience depression. I want to emphasize that this is a short-hand summary of thousands of people I have seen. Most depressed people will find they identify with some things on both sides of the chart. Some men will find themselves predominantly on the magnetic side and some women will find themselves predominantly on the dynamic side. However, most depressed men, I believe, will identify more with the dynamic depressions and most women will identify more with the magnetic depressions.

Tom Golden, an expert on male emotions and author of Swallowed by a Snake: The Gift of the Masculine Side of Healing recognizes that the ways men and women deal with their emotions, particularly those of loss, may be quite different. Women often express their emotions through talk and tears. Men often express them through action and reflection. The kinds of actions men engage are often related to creativity, thinking, and practicality Golden believes. [vi]

"Eric Clapton used creativity in writing a song about his four-year-old son who died in a tragic accident," says Golden. "C. S. Lewis wrote A Grief Observed which to this day is a classic in the grief literature. Mr. Lewis used his strength in writing and in thinking to do something that honored his wife and helped others."

"Michael Jordan used his experience as an athlete when he dedicated his season on the Chicago Bulls in memory of his murdered father. Remember the championship where Jordan fell to the floor after the Bulls won the game and was tearful and holding the basketball at mid-court? It turns out that this was the season he had dedicated to his father and they won the championship. Additionally, the game was won on Father's Day, which sharpened and amplified the emotion surrounding his efforts to honor his father."

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