How Do Men Experience Depression?by John Folk-Williams Patient Expert
It took me a long time to realize how extensive the influence of depression was in my life. That was partly because of a set of aggressive behaviors that I never associated with the illness. Researchers have singled out exactly these symptoms as typical of depressed men and very different from those experienced by women.
A few years ago, a Johns Hopkins health bulletin published an interesting and helpful list that contrasted the depression symptoms of men and women. Here are a few of the key differences they identified:
Women tend to feel sad and worthless, men angry and underappreciated.
Women withdraw when hurt, men attack.
Women feel anxious and scared, men suspicious and guarded.
Women believe they can solve the problem by being better partners, men by being treated better by their partners.
Women ask, am I lovable enough? Men ask, am I being loved enough?
Women blame themselves, men blame others.
That last one really clicked: men blame others. Those words immediately brought to mind a long and painful period when I did exactly that and caused my wife a lot of pain. Rather than face the inner hurt as my own, I pushed the pain onto the people I was closest to. Blame led to outbursts of rage and verbal abuse and a terrible feeling that I might be getting out of control. It was some relief to learn that this behavior was another side of depression, but it hardly made up for the emotional damage I had caused.
The research has revealed a lot more about depression in men. Not knowing how to get better, men often turn to alcohol or drugs for relief. They also create escapist fantasies of finding a new partner or a new job, convinced that a fresh start in life will end their problems. Risk-taking can also increase. Men might seek out dangerous sports, drive recklessly or look for sex outside marriage. Both the cause and cure for unhappiness are out in the world, not within - yet there is no recovery out there for them to find.
These symptoms are so different from what we think of as depression that it's hard to see the connection. The traditional criteria used in a diagnosis include prolonged periods of bleak and despairing mood, feelings of worthlessness, lack of mental focus, loss of energy, a tendency to isolate from contact with people - these and the rest of the criteria are all about passivity and inaction, not aggressive, action-oriented behavior. The contrast is a reminder of how complicated the phenomenon known as depression can be. Men don't imagine for a minute that depression may be their underlying problem. Denial comes easily when you can point to your wife or kids or job as the issue. The idea of treatment seems irrelevant or insulting.
But the anger and acting out aren't the whole story of men's depression, certainly not of mine. Men also experience depression in the more expectable ways, feeling so low and lacking in energy that it's hard to get out of bed. They can be overwhelmed with shame and despair, live with shattered self-esteem and lose the ability to focus on their work. It's hard to imagine that the two sets of symptoms could occur together. But that was exactly what happened to me.
I displayed many of the angry and aggressive symptoms for years without linking them to depression. And that was at a time when I knew I was depressed but only thought of it in conventional terms. I never even mentioned the outbursts of anger, the blaming and the rest to the therapists who treated me for depression. Nor did any therapist ever mention these symptoms until the last couple of years. So I went through periods of angry storming and periods of flat-on-my-back depression without understanding that they were different sides of the same disorder.
Terrence Real, the therapist and author of I Don't Want to Talk About It, calls the acting out behaviors covert depression. He describes numerous cases of men finally ending their anger and rage when they were able through difficult therapy to make a connection between their own emotional history of inner pain and their present experience. One of the reasons these breakthrough moments are so hard to get to relates back to the way these men grew up. It's also the way I grew up.
As Real points out, boys learn early, as I did, to break away from close ties to their mothers and from the feeling and nurturing sides of life. The message is clear: women take care of all that. Men put their feelings under lock and key in order to go out and fight to get ahead in what my father always called the rat race of earning a living. That meant scrambling through a crowd to get somewhere, kicking aside anyone in your way, fearful of being kicked out yourself. In my world, you were to run that race with style and finesse, but you still had to get the job done. There were all sorts of ways to measure how well you were doing, but money was the big one. If you didn't have money and the house and cars to go with it, you'd likely feel like a complete failure as a man. If you won, it was because you were strong and smart enough to make your own way. The whole idea was that you were on your own, looking out for yourself and your family and for no one else.
The strange thing is that all this became part of my life as a boy growing to manhood, even though my father only mentioned these values a few times, and no one tried directly to drill it into me. I learned and internalized the lessons about emotional control and restraint, about having to be physically strong and feel the power of being a man, about having to compete and be first as often as I could from what I observed and felt.
I learned about controlling feelings partly from watching my friends change from playful kids to restrained teenagers, putting aside "girlish" displays of emotion. I also learned to control my emotions in even more damaging ways within my family. There was a constant tension and simmering anger between my parents. When deep feelings came out, they were usually explosive and destructive. I walled myself off from that and kept myself as far away from showing or even feeling emotion as I possibly could. So the normal male restraint became more intense in me because it was a matter of survival not to be pulled into that dangerous realm.
So a depressed man - even one trying hard to deal honestly with inner pain - first has to undo a lot of learned life experience. The habits of emotional denial, blaming others for his problems, anger and aggression - and the rest - have to stop before meaningful recovery can begin.
Of course, many people have different experiences, and I'd like to know what your sense is of the differences between men and women when it comes to depression. Has your own upbringing and personality helped free you from the stereotypical roles of men and women? Do you think gender really plays a big role in the behaviors of depressed people?
In the next few posts, I'll go more deeply into my own experience of living through the aggressive side of men's depression. I hope we can have a good discussion about these issues.