Unmasking male depression

The last of a one-year series dealing with pastoral pressure points.

Archibald D. Hart, Ph.D., F.P.P.R., is professor of psychology at the Graduate School of Psychology, Fuller Theological Seminary, in Pasadena, California. He is the author of the book The Anxiety Cure, published by Word, that can provide additional help for the reader.

Do men get depressed? They certainly do. In this, the last of this series of articles, I would like to explore what I consider to be one of the most significant challenges facing many cultures today the issue of male depression.

Because male depression is wide spread, deeply misunderstood, and too often misdiagnosed, it desperately needs our attention. Pastors, in particular, need to be well informed on this topic; otherwise, the effectiveness of their ministry to men will be compromised, as will their understanding of themselves, if they are male.

As I reflect on more than 30 years of clinical experience, I am appalled at the realization that I have all too often misdiagnosed male depression. Of course, it was not really my incompetence that was to blame. The truth is that there's been a "cover-up." For decades, perhaps centuries, society has seen depression as a woman's condition. As a result, the symptoms of depression have become "feminized," and we have become indoctrinated with the idea that depression is a "woman's problem." We have become so accustomed to seeing how depression manifests itself in women that we don't expect to see the same symptom pattern in men. It is no surprise, then, that many deeply depressed men go untreated.

How to recognize male depression

Women are diagnosed as suffering from depression, mainly by exploring their feelings. Men are better diagnosed by paying attention to their behavior. Or, to put it more succinctly, women feel their depression; men act it out! Women get sad and try to "connect" with friends or seek to take care of someone else called the "tend and befriend" response.

On the other hand, men give vent to it through frustration and anger. They become irritable and moody. They don't connect, but withdraw, retreating into their cave while they give their loved ones the "silent treatment." It is this "masking" of depression that characterizes male depression.

Let's look at a typical example that illustrates how men experience depression. Stan is an up-and-coming insurance broker. This past year, because of the slump in the economy, he is failing to make the sales goals that his superiors have set for him. When he gets the news that he will not receive his anticipated year-end bonus and is reprimanded and given a warning that his job may be on the line if he doesn't improve, he doesn't go home sad, tearful, and grieving (which is what a healthy response to such a loss should be). He certainly doesn't seek out his wife to see if he can share his disappointment with her. No, Stan barges in the front door, throws his briefcase across the floor and screams at the kids who are making too much noise for his liking. He heads for his recliner in front of the TV, reaches for the remote, and tries to escape his problems.

From previous experience his wife knows that she had better not ask him how his day has gone, nor is it an opportune time to tell him that the washing machine is making strange noises. It is because Stan doesn't "connect" with his feelings of depression that he exacerbates them he creates a chain of further losses and alienation, called a "depression spiral." It may take weeks before he comes out of this spin.

I have done many radio programs with male depression as their theme and have talked to many wives in the process. Only a few have been able to accurately describe the classic symptoms of male depression. They say something like this: "He becomes irritable, short-tempered, withdraws into a shell, refuses to talk. When he responds, he overreacts; whether it be to the news, his dissatisfaction with his meal, or the kids' noise." A lot of spousal abuse could have depression as the cause or trigger. Essentially, any change in how a man expresses hostility and anger needs to be looked at as possible evidence for an underlying depression.

How men mask depression

Masked depression is one of the most prevalent disorders in modern society, yet it is perhaps the most neglected category in psychiatric literature. Our modern world is full of ways men can run away and hide from their depressive pain.

The reason is that depression can be overt or covert.

In overt depression the symptoms include the traditional sadness, lethargy, negativity, and mood changes. These are the hallmarks of classic depression female, that is. For men, depression is more covert. After all, we raise boys to be emotionally strong, and not to be "sissies" or "cry babies." It's not surprising, then, that when depression strikes the typical male, it doesn't connect so much with the feelings as on the behavioral level. It is not that sad feelings aren't there. If you dig deep enough you will find them. Rather, these feelings are shoved out of the way by distracting behaviors or numbing preoccupations of some kind. It is these distracting behaviors and preoccupations that "mask" male depression.

What are the common masks?

Among others, here are just four of the most common. Identifying these will help us get a better understanding of what men do with depression.

Anger, rage, and pent-up resentment. This mask is the dark side of male depression, and I have already alluded to it. It brings pain and hardship to the loved ones who must live with a depressed male, and along with the increase in the stresses of modern life, it is obvious that the incidences of depression have escalated proportionately, as have the occurrence of male rage.

Road rage, airplane rage, work rage, even rage on high school campuses (the Columbine syndrome) is every where. I suspect that much of this fury has some unrecognized depression as its root cause. Why? For one thing, I have seen it in myself and in many of my clients. Shortly after the Columbine incident in Colorado, it was discovered that at least one of the two young male shooters was on an antidepressant.

Workplace rage, in which a supervisor or colleague is killed, is always precipitated by a major loss, such as being fired. While other motives may be present, the experience of loss is a major cause of psychological depression. When the depression is successfully treated, the rage and anger subside. Men, therefore, need effective help in dealing with loss.

Workaholism. Here we have both a cause and effect for depression. Work can be a major distraction when it total ly engrosses a man. Overwork, particularly when it is demanding (and what work isn't?) is the most significant cause of stress in our society. In some societies, people literally work themselves to death.

The Japanese have a label for it—Karoshi! Americans call it "workaholism." It has been turned into a respectable mask for men. Whatever the name, it still devastates the serotonin neuro-transrnitter system in the brain causing depression. But again, work not only causes depression, it also serves as a mask for depression.

Avoidance of intimacy. The last thing a depressed male wants to do is "connect" in any form, especially if it involves intimacy. However, for the typical male, sex is not necessarily an expression of intimacy, so this is not always excluded. The depressed male becomes cold and indifferent to his wife, family, and friends. He withdraws and clams up.

If this isn't bad enough, he takes it one step farther and begins to search his environment for reasons for his down feelings (he hardly ever calls it "depression"). This quest often focuses on his family and may result in a lot of faultfinding and blaming when it comes to those who are close to him.

Sexual compulsions. If there is one biological and psychological mechanism with the power to relieve depression's pain, at least temporarily, it is sex. Except in severe depression, most melancholic men don't totally lose their desire for sex. As I've observed many of my male clients, I have formed the opinion that many of those obsessed with sex are so because sex provides them with some pleasurable relief from their low mood. For them, sex becomes a self-medication of sorts.

Causes of depression

I cannot cover all the causes of depression here, but Christian leaders will find that some understanding of the causes of depression will be helpful as they try to help others overcome it.

Earlier I mentioned that a significant loss in a person's life can cause depression. The more significant the loss is, the greater the depression. This form of depression is called "reactive depression" and is a form of grief.

Usually, medication is not of any help, and the man needs to be helped in the grieving process. Getting fired from a job can be just as devastating to a man as the death of a parent or close friend.

Genetic factors can also cause depression. We may well see severe depression in several members of the same family. Fortunately, this form of depression is probably the easiest to treat since antidepressant medications are specifically designed to counteract the effects of the gene on the brain's neurotransmitters, or chemical messengers.

Hormonal and thyroid problems (common in women) can also cause depression. Something called the "serotonin/ depression dance" explains why women get depressed when their estrogen levels drop (each month, after childbirth, and with the onset of menopause). The drop in serotonin pulls the serotonin level down, and this causes depression. Here too, antidepressants can work wonders. But these causes don't explain the epidemic of male depression we are now seeing. The only explanation is that stress is the culprit, and in some respects this also exacerbates female depression.

How does stress cause depression?

The stress hormones, called "glucocorticoids," are the culprits, especially one called "cortisol." It targets at least two areas of the brain: the synapses, where it reduces the number of neurotransmitter receptors, and the hippocampus, where it disturbs the brain's capacity to renew its cells. That's the bad news about stress.

The good news is that the condition is reversible by lowering your stress and, if necessary, using the same antidepressants that are effective in genetic forms of depression. However, when combined with psychotherapy you have the greatest chance of beating it! And then, of course, there is also the resource of spiritual guidance, because depression can make it feel as if Cod is far removed from you.

So the message is clear. We have to help men become more aware of when they are depressed and encourage them to seek appropriate help. Men typically don't seek help. They see depression as a sign of weakness. But their cowardice in not dealing with their depression is the real weakness!

Living with a depressed man

It is most unfortunate that many depressed men, including those who are Christian, refuse to go for treatment. Some who seek treatment don't respond satisfactorily. And even when treatment is successful, a depressed male can still be a bear to live with! Wives, mothers, and daughters of depressed men need all the help they can get to pull themselves through these difficult times.

Why is it so much more difficult living with a depressed man than with a depressed woman? Husbands of depressed women can at least escape in their work or retreat to a hobby or golf course. Wives of depressed husbands have nowhere to hide. Many quit their jobs just to take care of their husbands. Also, men are the ones who are sup posed to be strong, not weak, and wives often struggle with this "reversal" of strength and dependence, finding that the adjustment is not easy for them to make. They hate having to be strong for both themselves and their husband!

Depressed men also frustrate and alienate those they love most. It's almost as if they have a need to blame someone for their depression, and the one who loves them the most is the easiest to target. So the more women love their depressed husbands, sons, or fathers, the greater is the potential for them to cause hurt. Those who glibly say, "Don't take it personally," don't really understand what's going on. It's easier said than done.

What is the most important thing that a woman can do for the depressed male in her life? Without a doubt it is to communicate love and acceptance with all the power she can muster. It may take a supernatural intervention, so help her to rely on God for the grace and patience that will be needed.

Emphasize that a woman's loved one has not intentionally chosen to be depressed. Although there may be a few exceptions, most men would gladly give up their depression if they could. So we need to try to help the loved one under stand that the male's "bad" behavior is coming from his depression.

With God's help, in the long run, unconditional love can make a differ ence for both husband and wife, and also for other family members. Even though the depressed man may never show any appreciation for this love at the time, the day will come when the wife or mother will look back with satisfaction over the way she has handled the depressive reactions of the man in her life. For her, as with other challenges in her life, God's promise to Paul applies: '"My grace is sufficient for you, for my power is made perfect in weakness'" (2 Cor. 12:9, NIV).

For more help in how to deal with depressed men, we highly recommend Dr. Hart's book, Unmasking Male Depression (Dallas: Word Publications, 2001).

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Archibald D. Hart, Ph.D., F.P.P.R., is professor of psychology at the Graduate School of Psychology, Fuller Theological Seminary, in Pasadena, California. He is the author of the book The Anxiety Cure, published by Word, that can provide additional help for the reader.

November 2002

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