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men and depression

by Bruce Mackie

My work with men has led me to conclude a great deal of male depression is misunderstood and misdiagnosed and consequently, unrecognized and untreated. I know behaviours that are immature, cruel, aloof or selfish are frequently disguised and distorted expressions of sadness and despair. New Zealand suicide studies reveal a high percent of completed suicides had a problem with conduct disorder (approximately 40%).

It is of great concern to me that the focus of individuals and agencies is most commonly on the outward appearance of problem behaviour. Popular attention is so concerned about facing men with responsibility for the consequences of their destructive behaviour that the emotional pain that drives those behaviours commonly goes unrecognized or addressed.

Anger management and stop violence courses are plentiful and invariably target men – they are devoted to addressing destructive behaviour and sadly, vilify men. This does not mean I advocate male destructive behaviour has to be excused or condoned. On the contrary, many men do behave in ways that cause others to suffer badly and there is nothing that absolves them of the responsibility for those consequences. However, it is easy to become so behaviour focused that we fail to recognise the pain that begets the behaviour and that many disturbed men behave in disturbing ways.

Diagnostic criteria describe women’s depression

The current criteria for diagnosis of Major Depression (DSM-IV) are:
  • depressed mood
  • diminished pleasure in activities
  • significant weight change
  • over sleeping or unable to sleep
  • psychomotor agitation or retardation
  • fatigue or loss of energy
  • feelings of worthlessness or guilt
  • diminished ability to concentrate or make decisions
  • recurrent thoughts of death
These criteria describe a typically depressed woman and it is not surprising therefore that our current statistics indicate women are diagnosed with depression twice as often as men. This pattern is sometimes referred to as “acting in” because the focus is on internal feelings rather than external behaviours.

However, it is considered unmanly to act in that way so when men experience emotional pain they tend to react with anger, self-destructiveness and/or by distracting themselves with behaviours such as drinking, workaholism, promiscuity etc.

Men's symptoms of depression are different from women’s

Men are raised to be independent, active, task-oriented and successful; consequently they tend to express painful feelings by blaming others, denying their own feelings and finding solutions for their problems in places outside themselves. Whereas women tend to “act in” in reaction to negative feelings, men tend to “act out”.

Most depressed men are not even aware of their depression because they are very disconnected from feelings and because their behaviours do not have the “typical” depressed appearance.

Male depression is characterised by dissociation from feelings and destructive behaviour in relationships; the first process leading to the second. It is this lack of awareness of natural human reactions and inner experiences – the disconnection of feelings from conscious experience – that results in a variety of interpersonally destructive behaviours. Distancing, bullying, neglect and violence as well as other indirect behaviours such as workaholism, dangerous risk taking, substance abuse and health difficulties are common unrecognized manifestations of masculine depression.

There is a great deal about traditional masculinity that encourages men to become dissociated from their feelings and destructive in their relationships. However, that result is not inevitable. My professional work with men, my experience of living in the world as a man and my understanding of the influence of gender demands in men’s lives have all contributed to my thinking about male depression. This is not to say it is universal for men to portray depression in this way, some men do portray classic symptoms of depression and a few women “act out”. It is however a common problem for men.

Depression is composed of feelings that include helplessness, hopelessness, worthlessness and loss. Aaron Beck in the Cognitive Triad reminds us that depressed people experience the world as hostile and unsafe, they believe the future holds little if any hope of being better than the past and they perceive themselves as worthless. What people do about their pain differs and men tend to react differently than women.

Lifting men's depression

To begin the process of healthy change, it is important a therapist has an accurate understanding of the pain that drives the symptoms of masculine depression. This is an understanding that neither victimizes nor pathologises men. Then in order for a man to change behaviour, he must change his relationship first with himself, then with other men, with his father, with women, with family and with community. This process is the responsibility of males. Too often we hear domestic violence and other male behaviours described as a “women’s issue”. It seems to assume that male destructive behaviour in relationships is inevitable and we should only concentrate on victims. Violence will only stop when men recover their full humanity and when men help other men to do the same.

Male depression is a serious mental health problem that leads to violence, abuse, and self-neglect, that destroys relationships and lives. This male disconnection from themselves and others is a central issue in the contemporary crisis of gender.

There are some excellent books that explore men’s healing of depression – Lynch and Kilmartin in “The Pain Behind the Mask”, Terrence Real’s “I Don’t Want to Talk About it” are two such resources.

This article was originally published as an Editorial in the Lifeline Newsletter (May 2000) and is reprinted here with the kind permission of Lifeline.

Bruce Mackie is a former Director of Lifeline Auckland.

Article posted 20 May 2007