Depression is often viewed as a predominantly female affliction. But this may be because the condition is often overlooked and misunderstood with respect to men, according to Terrance Real, senior faculty member of the prestigious Harvard-affiliated Family Institute of Cambridge, therapist and author. Terry talks here about why male depression is underrecognized and what men can do about it.
Q. Why is male depression underdiagnosed?
A: The conventional wisdom is that the rate of depression in women is two to four times the rate of men. But depression is experienced and expressed differently in men and women. Depressed men don't reach out for help in the same way that women do.
In this culture, we don't like men to be too expressive of their feelings or too openly vulnerable. Depression is seen as unmanly and shameful. It carries a double stigma for men -- that of a mental illness as well as femininity.
Q: In your book, you refer to two types of male depression, covert and overt. What is the difference?
The signs of overt depression include fatigue, feeling sad or blue, having difficulty sleeping and experiencing changes in eating. With covert depression you don't see the depression. What you see are the footprints of depression or the defenses a man is using to run from it.
What are these "footprints"?
A: Covert male depression has three main domains: self medication, isolation and lashing out. Self-medication may be drinking, drugging, womanizing and even watching excessive amounts of television. Some forms of self medication are tolerated by our culture so it is hard to get across that what these men are doing is stabilizing depression.
A covertly depressed man will isolate himself and withdraw from intimacy with his partner, his kids, his friends. He can't afford to be intimate with others because he is desperately trying not to be intimate with himself.
Lashing out can mean violence and domestic abuse. Untreated depression may be an integral part of many male batterers.
Q: How common is covert male depression?
A: For every man who suffers from overt depression, there are probably five who suffer from covert depression.
Q: Can women be covertly depressed?
A: There are some covertly depressed women. But girls and women are allowed to be expressive, connected and vulnerable while men are taught to be aggressive, assertive, independent and disconnected.
Q: What advice do you have for men who suspect they may be depressed?
A: Get help. Get help. Get help. Depression is highly treatable and these men need therapy. Unfortunately, covertly depressed men rarely seek help on their own. It is almost always the people around them who persuade them to initiate therapy.
Q; What advice can you offer a woman whose boyfriend or husband appears to be depressed?
A: My advice to that woman is to be empowered. Even though it may seem frightening, she must confront the man and say, "I think you are depressed and I think you need help." The guy may agree or he may stonewall her. If the latter happens, the next step is to say "If you don't think you have a problem, then we have a problem as a couple and we need help."