from chapter one

Men's Hidden Depression

One of the ironies about men's depression is that the very forces that help create it prevent us from seeing it. Men are not supposed to be vulnerable. Pain is something we are to rise above. He who has been brought down by it will most likely see himself as shameful, and so too may his family and friends, even the mental health profession. Yet I believe that it is this secret pain that lies at the heart of many of the difficulties in men's lives. Hidden depression drives several of the problems we see as typically male: physical illness, alcohol and drug abuse, domestic violence, failures in intimacy, self-sabatoge in careers.

We tend not to recognise depression in men because the disorder itself is seen as unmanly. Depression carries, to many, a double stain - the stigma of mental illness and also the stigma of 'feminine' emotionality. Those in a relationship with a depressed man are themselves often faced with a painful dilemma. They can either confront his condition - which may further shame him - or else collude with him in minimzing it, a course that offers no hope for relief. Depression in men - a condition experienced as both shame-filled and shameful - goes largely unacknowledged and unrecognised both by the men who suffer from it and by those who surround then. And yet, the impact of this hidden condition is enormous.

Eleven million people are estimated as struggling with depression each year. The combined effect of lost productivity and medical expense due to depression cost the United States over 47 billion dollars per year - a toll on a par with heart disease. And yet the condition goes mostly undiagnosed. Somewhere between 60 and 80 percent of people with depression never get help. The silence about depression is all the more heartbreaking since its treatment has a high success rate. Current estimates are that, with a combination of psychotherapy and medication, between 80 and 90 per cent of depressed patients can get relief - if they ask for it. My work with men and their families has taught me that, along with a reluctance to acknowledge depression, we also often fail to identify the disorder because men tend to manifest depression differently than women.

Few things about men and women seem more dissimialr than the way we handle our feelings. Why should depression, a disorder of feeling - in psychiatric language, an affective disorder - be handled in the same way by both sexes when most other emotional issues are not? While many men are depressed in ways that are similar to women, there are even more men who express depression in less well-recognised ways, ways that are most often overlooked and misunderstood but which nevertheless do great harm. What are these particularly male forms of depression? What are their causes? Is the etiology of the disorder the same for both sexes? I think not. Just as men and women often express depression differently, their pathways towards depression seem distinct as well.

Traditional gender socialization in our culture asks both boys and girls to 'halve themselves'. Girsl are allowed to maintain emotional expressiveness and cultivate connection. But they are systematically discouraged from fully developing and exercising thier public, assertive selves - their 'voice' as it is often called. Boys, by contrast, are greatly encouraged to develop their public, assertive selves, but they are systematically pushed away from the full exercise of emotional expressiveness and the skills for making and appreciating deep connection. For decades, feminist researcheers and scholars have detailed the degree of coercion brought to bear against girls' full development, and the sometimes devastating effects of the loss of their most complete, authentic selves. It is time to understand the reciprocal process as it occurs in the lives of boys and men.