Last week the media reported the sad and unanticipated deaths of two men. Derek Boogaard of the Rangers died from an accidental overdose of the drug oxycodone mixed with alcohol and retired lieutenant, John A. Garcia, a 23-year veteran of FDNY who not only responded to 9/11 but responded and lost two of his men in the Deutsche Bank Fire. died by suicide.
One can’t help but wonder if the tragic deaths reflect the danger of hidden depression in men. Increasingly we have become aware that although women are twice as likely to be diagnosed with depression, many men, beyond the 10-17% diagnosed, may also be suffering with depression.
Depression May Be More Deadly for Men
What makes depression in men so dangerous? It too often goes unrecognized and untreated because it is masked by physical complaints, substance abuse, anger and other stealth symptoms.
Why is Depression So Well Hidden in Men?
A mix of biological and cultural factors often conspire to keep men and those who love them from recognizing and addressing their depression.
Different Symptom Patterns
Given that women are twice as likely to suffer with depression as men, there is a tendency, even in clinical diagnosis to associate depression with symptoms more likely reported by women as sadness and hopelessness, trouble sleeping, changes in appetite, loss of interest in people and activities, and suicidal thoughts.
According to the STAR-D study, there are physical differences in the overall pattern of depression symptoms between men and women which may go unnoticed:
Whereas both men and women may report low mood as a symptom of depression, women are more likely to gain weight, men more likely to lose weight; women report symptoms associated with anxiety, men report symptoms associated with obsessive –compulsive disorder; women feel less energetic, men feel agitated; and men are more likely to develop alcohol or substance abuse in conjunction with major depression.
Differences in Handling Feelings
In his cross-cultural research on depression, Jules Angst MD found that both men and women reported stress as a cause of their depression. Whereas women cited family as the primary source of stress, men were more likely to cite work and unemployment.
Impact of Culture on Men and Depression
Recognizing depression and the feelings associated with it is culturally more difficult for men than women.
Marianne Legato MD, expert in gender-specific medicine, notes
“I have long been convinced that depression is underreported, underdiagnosed, and underetreated in men, largely because of the way they’re socialized.”
Men are taught directly and indirectly not to cry in sadness or pain. The message internalized by too many is not to talk about feelings- not to talk about depression. As one marine, who had tragically covered his pain with alcohol described,
“I was trying to be the tough marine I was trained to be — not to talk about problems, not to cry,”…“I imprisoned myself in my own mind.”
The Right to Recover
Unlike other illnesses there is a tendency to associate depression with weakness, vulnerability, laziness and withholding. There is a tendency to feel shame and self–blame even as one is suffering.
The reality is that 19 million Americans suffer from depression. They suffer physically and emotionally.
Men and women don’t cause their own depression – be it a function of genetic predisposition, hormones, stress, loss, disappointment, grief or trauma – they suffer with an illness that can and should be treated.
Men often suffer alone. If they stop to consider that their physical symptoms and behaviors might hide depression- they may be able to step out of danger.
If they reach for the help of a partner, a buddy,their primary physician, a mental health professional, or a spiritual caregiver- they will have taken the first step.
Ursano, R., Grieger, McCarroll.1996. Prevention of posttraumatic stress: consultation, training and early treatment. In Traumatic Stress: The Effects of Overwhelming Experience on Mind, body and Society, (Eds) B. a van der Kolk, A. C. McFarlane, and Weisaeth. New York: Guilford Press.
Photo by Alan Turkus, available under a Creative Commons attribution license.
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From Psych Central's World of Psychology:
Best of Our Blogs: May 27, 2011 | World of Psychology (May 27, 2011)
A Guide To Symptoms Of Depression In Men | xtend-life-reviews-products.com (October 16, 2011)
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Recognizing and Understanding Depression After Trauma | Healing Together for Couples (August 10, 2012)
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Understanding Anger in the Aftermath of Trauma and Disaster | Healing Together for Couples (January 22, 2013)
Last reviewed: 3 Aug 2011