A Man Depressed - The Problem of Treatment
Although I’ve been fairly receptive to getting help for depression, I went through a long period of refusing to consider it and denying that I had a problem, even though I needed treatment more at that time in my life than at any other. When I read about the stereotypical behavior of men in dealing with their emotions, I have to say I was a living, breathing example of everything the studies say about my gender.
I was out of touch with my feelings, got angry and aggressive instead of overtly depressed, denied have any emotional problem (in fact, I’d get angrier while denying I was angry), never talked about my feelings, believed I could handle any problem on my own and blamed others for any unhappiness I might be experiencing.
Getting help was out of the question - who needed help? But one crisis after another finally left me with nowhere else to go, and I went to see a psychiatrist for the first time in 10 years. Even then, I wasn’t willing - let’s be honest, I was scared - to discuss everything I was going through and tended to understate and dodge the really tough stuff. So it took another five years and several further crashes before I really opened up and made my own commitment to work as hard as I could to recover from depression.
I know a lot of men who have been through this cycle of moving ahead a step, then back again, never quite able to make the full commitment to follow through with treatment. This ambivalence and the difficulty in being honest about emotions don’t disappear, even after a man has admitted he has a problem and takes the first step toward getting help. The inner drag on openness can continue to color every phase of the treatment process, right from the first visit to a doctor’s or therapist’s office.
To begin with, he may seek help for a problem, but not the problem of depression. It’s much easier to talk about other symptoms that men experience like uncontrollable anger, anxiety, nightmares, insomnia or trouble at work than about a mental disorder like depression. One study quotes a great example of this form of avoidance by a man during an intake interview. He reports having trouble sleeping, concentrating, doing well in his classes.
When prompted, he says that at about the time those problems started, his girlfriend broke up with him. He denies being sad about that, and when asked by the therapist what he’d like counseling to accomplish he says: “I want you to help me not think about it.” Hopefully, he got beyond that expectation during the counseling sessions, but his initial description of the problem sounds all too familiar to me.
Research bears out that idea that men don’t say a lot. As some doctors report, men tend to “undersell” their symptoms. Other providers describe what they see as gender differences: men bring out their symptoms in the midst of a crisis, women before a crisis. Some confirm the difficulty men have in identifying the underlying problem: they talk about physical symptoms instead of their state of mind. Either they don’t think much about feelings or they believe that talking about them will only make things worse. They’ll be “wallowing” or succumbing to negative emotion instead of doing something they think is positive, like going out with cheery friends to have a good time.
Not only do men seeking help have trouble, but it turns out that doctors have their own issues about diagnosing depression in men. Male physicians tend to share some of the same stereotypical attitudes that lead depressed men to deny depression or any emotional problem as a sign of weakness. They are less inclined, then, to raise depression as an issue, at least initially, or may go along with a man’s self-reported symptoms and prescribe medication for sleeplessness or anxiety. The underlying condition may also go unnoticed because the classic diagnostic criteria, such as depressed mood and loss of self-esteem, are missing or unreported. One result is that health providers are more likely to diagnose depression in women than in men.
As the therapist, Terrence Real, points out in his classic book, I Don’t Want to Talk About It :
A number of studies looking at who gets labeled as being depressed have been carried out nationwide. Some ... have been conducted on a massive scale. The results of most of them show a tendency of mental health professionals to overdiagnose women’s depression and underdiagnose the disorder in men.
Another problem is that the first person many men - or women, for that matter - go to see is their primary health physician rather than a psychiatrist or therapist. That’s the way most health insurance plans in the U.S. work. You start with your general practitioner who may or may not give you a referral to a specialist. Even if the doctor gets the diagnosis exactly right, he or she can only prescribe antidepressants and perhaps make that referral to a psychiatrist or therapist. Many men will accept the medication but pass on anything that involves talking about emotions.
But let’s say our depressed guy gets his diagnosis, takes medication, makes a serious effort at therapy, feels better - but a month later is right back where he started. The depression is worse than ever. He’s likely to blame the treatment as a waste of time and never bother with it again. He believes that he stretched himself by agreeing to all that emotional talk and look where it got him - nowhere!
It’s hard to face the reality that a one-shot approach to treatment usually doesn’t work for severe depression. The expectation with other forms of medical treatment for physical diseases is that doctors and their prescriptions will provide the cure. You “undergo” the treatment passively.
Responding to a disorder like major depression, especially its recurrent form, requires a different attitude. You have to become an active partner because, whatever the treatment, you will likely need to change how you think about your experience, how you handle relationships and how you deal with your emotions. These are life skills and habits that take time and commitment to develop. Medication alone won't do it.
So all this adds up to more than many men want to deal with - until they are really at rock bottom. Life is crashing all around them, and they finally know this is it. They’ve got to do something drastic and deeply commit to treatment for as long as it takes.
Unfortunately, many men won’t budge even at that point and keep right on blaming their wives, their work, the place they live for whatever disaster may be happening. So they leave everything behind to start a new life that will end every conceivable problem. Therapy is for all those twisted people who are causing their problems, certainly not for them!