Men and Depression

Author: Alexandra Smith, LPCC – Therapist

Studies show that women are diagnosed with depression at twice the rate of men. But is depression really more common for women – or do the signs get missed among men?

In his book “I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression”, psychotherapist Terry Real distinguishes between overt and covert depression. When an individual is experiencing overt depression, they recognize that they are depressed. They experience symptoms such as crying, difficulty focusing, feelings of worthlessness and self-defeating thoughts: I’m a failure; nobody likes me; the world is a terrible place.

Overt depression is painful, but the pain can ultimately be seen as a positive thing if it motivates the individual to get help.

By contrast, explains Real, the covertly depressed individual does not identify as depressed. While deep down they may be suffering from immense loneliness, sadness and shame, numbing mechanisms like drugs, alcohol, or even long hours at the office or playing videogames allow them to avoid reckoning with their pain. Covert depression is by definition unacknowledged depression, and therefore all too often untreated depression.

Covert depression can manifest among anyone, but men remain more vulnerable. Why?

Often socialized from birth to value stoicism and devalue emotional expression and interpersonal connection, men tend to be less inclined to discuss or even acknowledge emotions like sadness, hurt and fear. Additionally, men and boys tend to receive positive reinforcement for channeling emotions through aggression or denial, learning that boys shouldn’t cry but instead settle misunderstandings through violence or silence (think stonewalling or storming out of the room when their partner wants to talk). Not only does this prevent boys from learning healthy communication and emotional regulation skills, caregivers may focus on addressing the problematic behavior rather than the emotions underneath it. When this happens, depression remains covert.

Substance abuse, which occurs at roughly twice the rate in men compared to women (1), poses a similar challenge. Too often those struggling with substance abuse seek treatment for the addiction without addressing the underlying emotional pain they’ve been blunting with drugs or alcohol.

Then there’s the issue of loneliness. Studies suggest men are less likely than women to have close friends with whom they confide about their emotions. A lack of social support not only exacerbates depression, it increases the likelihood of ‘suffering in silence’ – or ignoring the suffering altogether.

I have worked with many men who came to therapy because someone else – a partner, a boss, sometimes even a judge – ordered them to do so. Often they deny that anything is wrong or at most resort to vague statements like “I get frustrated a lot” or “things just seem off.” They tend to endorse the more observable or somatic symptoms of depression, like poor sleep or difficulty concentrating, but deny the emotional component. It’s not necessarily that these clients believe themselves to be happy but that they believe themselves to feel nothing at all. “I’m not sad,” said one man I treated. “I’m just numb.”

Real maintains that the only cure for covert depression is overt depression. Grief, hurt and sadness don’t last forever – no emotions do – but they can only pass through if we allow ourselves to fully experience them. Therapy provides a safe place to acknowledge and process difficult emotions. A trained therapist can also help identify and change the thoughts and behaviors contributing to depression, enabling individuals to build healthy relationships with others – and with themselves.

Stigmas around mental health are beginning to fade, but many individuals remain reluctant to seek help when they’re struggling. The ‘tough it out’ mentality dies hard, especially among men. That’s why it’s so important to not only normalize depression but look for it beneath the surface.

Here’s what to watch for:

  • A pattern of turning to drugs, alcohol or more subtly addictive behaviors like workaholicism as a means of avoiding difficult emotions or issues
  • A trauma history, especially one involving interpersonal trauma such as abuse from a caregiver. The aftermath of trauma echoes on in many forms, including pervasive feelings of disconnection and detachment as well as emotional numbness – all hallmarks of covert depression
  • A lack of close, supportive relationships. Living with covert depression involves living in a perpetual state of denial and avoidance, and it’s impossible to have genuine relationships when you’re hiding behind a shield
  • Inconsistent sleep or appetite, migraines, digestive issues and other somatic complaints that don’t have a medical origin. Often our body knows something is wrong before our head does

The beautiful thing about asking for help is that once you do, you’re already heading in the right direction. Acknowledging struggle is the first and most important step towards overcoming it. If you or someone you know seems to be experiencing covert depression, know that help is out there.

(1) – https://www.cdc.gov/alcohol/fact-sheets/mens-health.htm