Depression among men: Hidden and misunderstood
Men do become depressed. This is a seemingly obvious statement. What is less well known to men, health care professionals and the public however, is that many more men are depressed than we realise.
On 30 March , the World Health Organization made the startling announcement that depression is now the primary cause of disability and ill health worldwide. Moreover, depression can lead to suicide and a person dies in this way every 40 seconds. In many countries, including South Africa, about four times more men than women die by suicide. Yet women are four times more likely to be diagnosed with depression. This discrepancy suggests that there are more men who are depressed than statistics show.
There are several reasons we may think of men as unlikely candidates for depression. Cultural expectations that ‘big boys don’t cry’, that men should keep a firm grip on their emotions, be tough and always able to cope with life’s demands, are an important factor. For instance, like most people, health care professionals are prone to seeing depression as a ‘female disorder’ and therefore miss signs of depression in men. In addition, men tend to be less adept at recognising symptoms of depression in themselves than women do.
It is becoming increasingly evident that depression in men may not look exactly the same as in women. While some men do experience the classic symptoms such as a loss of interest and pleasure, energy loss, concentration problems and feelings of worthlessness or guilt, they also experience and express additional symptoms or ‘depressive equivalents’.
For instance, men may ‘do depression’ differently than women. This means that they use avoidance strategies such as spending a lot of time at work, watching television or doing all manner of things in order not to think about their problems. Risky behaviours such as having an affair and using drugs or alcohol to self-medicate are also often used as means to dull or escape emotional pain. These strategies are, of course, usually ineffective and often exacerbate the problem; alcohol does not alleviate depression and overworking or having an affair are usually damaging to relationships.
Some men may also ‘feel’ depression differently than women do. Men are more likely to be aware of depression’s physical symptoms such as losing weight, difficulty in sleeping, or feeling tired. Depressed men may experience intense irritation or anger, which may escalate into aggression. For some men, it may be far easier to be angry or hurtful than to show sadness or despair because these behaviours are considered more manly. Women, on the other hand, are more likely to feel sad and worthless.
In essence, these behaviours show that some depressed men try very hard to hide their depression from others and themselves. This is why depression is seldom diagnosed in men.
Without acknowledgement and diagnosis there is no treatment. While health care practitioners are becoming more sensitive to how men express and experience depression, it may continue to be difficult for men to recognise and acknowledge it. Most men Find it difficult to ask for help as it signals weakness and vulnerability, which are seen as unmanly. A man may also feel that he will be stigmatised as weak and unable to cope if he does seek help.
But there are men who are manning up to depression. Bruce Springsteen openly admitted that depression led him to seek professional help for the past 30 years. Abraham Lincoln, Winston Churchill, Jim Carrey, Leonard Cohen and even Buzz Aldrin have all experienced depression. Fame, fortune and success do not protect a man against depression. Like women, men may even experience depression before or after the birth of a child or in the event of a partner’s miscarriage.
Depression is highly treatable by means of medication, psychotherapy or both. The first step though is to recognise it.
Depression is more than just a dip in mood. It distorts the past into a terrible history, darkens the future and throttles the present. It profoundly affects the way you see the world, others, and yourself – the way you live and love in the world.
Adri Prinsloo is a clinical psychologist at the University of Pretoria’s Department of Psychology. She is currently completing a doctoral thesis on the ways men experience and express depression and how health care professionals can best assist these men.
– Author Adri Prinsloo