Hey, Bob, et al.
I saw your post on the weekend but waited until this AM to reply because composing a long reply on an iPhone, with links, would have been painful.
No worries at all about stepping on my toes or turf. You did not do that, of course, because I have no exclusive claim to psychiatric topics here or anywhere.
Let me add my kudos for your post. You spoke from the heart about very personal issues and tied them to societal health concerns and a concern for your fellow Axiomites. Your encouragement may indeed help others get healthier.
I think that you are on the money about male depression. It is often missed, both by the person suffering from it and from the health providers that he sees. The potential reasons for this include societal (and inner) pressure to just “suck it up/get a grip”, the general stigma of having a psychiatric condition or seeing a psychiatrist, the gender-specific stigma of having depression as a man, and the ways that depression can present differently in men.
There’s lots of good books out there on masculine depression. One is
The Pain Behind the Mask: Overcoming Masculine Depression. The authors identify two defining characteristics of masculine depression: dissociating from feelings and acting out suppressed feelings in destructive behaviors.
If a man is not in touch with his feelings because he is consciously or unconsciously pushing them aside – due to their unpleasantness – then it is not surprising that a lot of depressed men, including Bob, will not think of themselves as sad or depressed. I think that situations like this help explain why the diagnostic criteria for Major Depressive Disorder do not actually require a person to identify his mood as sad. The diagnosis is made when a person has five of nine criteria, one of which must include either sadness or anhedonia, which is a significant decline in interest of pleasurable activities. You know, when you just don’t feel like doing the things that you used to do for fun. The bottom line is that the cluster of symptoms leads to a significant decline in functioning lasting at least two weeks (and is not explained by substance abuse – because then the diagnosis changes – or by another psychiatric condition which would take precedent, like bipolar disorder, or by bereavement, which is a separate issue).
The other defining characteristic, according to Lynch and Kilmartin, also helps explain why depression is often missed in men. Rather than appear sad, a man will appear angry. He’ll get irritable, and people will think he’s just a jerk. Or he’ll hit the bottle, and he’ll be identified as an alcoholic, when really, the roots of the alcoholism were in a depression. Or he’ll hit his wife, and he’ll be diagnosed as bipolar, or just arrested and never diagnosed. Or he’ll wonder why he can’t stop cheating on his partners and looking at porn. Sometimes there’s an emptiness inside that he’s trying to fill, not realizing that he’s depressed because he just doesn’t understand his true feelings.
I’ll stop sermonizing for now – but again, thanks for shedding light on an important subject, Bob.
