The number of men taking their own lives has been steadily increasing since 2001 and is currently the highest it has ever been. Suicide is now the U.K’s leading cause of death in men under 50. The figures are alarming and yet only 25% of the people currently seeking help for depression in the U.K are men.
According to the DSM IV diagnostic criteria for a major depressive disorder, individuals need to report five or more of the following symptoms during the same two week period:
- depressed mood or irritable, most of the day, nearly every day
- decreased interest or pleasure in most activities
- significant weight change (loss or gain) or change in appetite
- change in sleep (insomnia or hypersomnia)
- agitation nearly every day
- fatigue or lack of energy
- feelings of worthlessness or excessive or inappropriate guilt
- diminished ability to think or concentrate, indecisiveness
- thoughts of death and suicide (with or without a plan)
Assessment of any disorder relies primarily on self disclosure. This immediately raises two key problems for men with depression. Firstly, men are much less likely to go and see a doctor and secondly, there is a huge amount of shame associated with men talking about their feelings, which means that even if they did see a doctor they may not discuss their true symptoms.
John McLachlan, author of‘ The Hidden Face of Male Depression in Business who has observed male behaviours in the corporate world for over 20 years, says: “Men are taught that ‘big boys don’t cry’, they have to suck it up and just get on with it. From a young age men are taught that it is okay for them to be tough, assertive and strong but it isn’t okay to be vulnerable or show signs of not being able to cope. To be a Hollywood hero you may be riddled with bullet holes and have one arm hanging off, but you must not slow down for one second.”
This yearning for perfection is not restricted to men, but it presents differently in women. McLachlan’s co-author Karen Meager explains: “Women are more consumed with appearing slim, beautiful, helpful and kind. They don’t experience that strong drive to be tough and to be the protector. These are unhealthy states for both sexes, but the shame associated with expressing emotion is so deep rooted in men that they are often unable to tell doctors how they feel, even if they want to. It is incredibly sad but they are more likely to choose a course of action, for example, suicide, rather than face the apparent shame and ask for help. Women, on the other hand, like to talk and share, if they are feeling low, they may tell a friend, a co-worker or a relative.”
So how can we tell if a man in our lives is depressed? Men are not any less emotional than women, but as a result of the social conditioning they are raised with, they are taught to lock those emotions away. Repressing feelings and suffering in silence becomes overwhelming and men typically act out their emotions, rather than expressing them, in a bid to feel better, even for just a few seconds.
According to Meager and McLachlan, the two most common behavioural representations of depression in men are: addictive behaviours and inappropriate behaviours. Addictive behaviours refers to negative behaviours such as alcohol abuse, affairs and gambling, but also to less obvious, seemingly positive behaviours such as exercise and working long hours. It is important to understand that any behaviour in excess is unhealthy and often an indicator of a deeper issue.
Inappropriate behaviours may refer to sexually inappropriate behaviour, increased aggressiveness, criminal activity, inappropriate banter, teasing or bullying. Of course these behaviours are not always symptoms of depression and an important differentiation is that a depressed man will feel bad after such behaviours and may go to some lengths to hide them, which will further fuel his feelings of worthlessness and guilt.
So, what is the best way to respond? For friends and family who suspect a loved one may be depressed, it is important to let them know you are open to listen, without forcing them to talk, as this may push them further away. It requires a great deal of patience and understanding and it is vital that others avoid entering ‘fix it mode’. Meager tells me: “women in particular often take it upon themselves to sort the issue. They insist the men in their lives see a therapist and go as far as booking appointments without even asking. This can be overwhelming and make someone who already feels useless, even more so. An individual knows when they feel ready to speak to a therapist, and may arrange to do so when that time comes.”
If and when a man does decide to see a therapist, Meager and McLachlan believe that psycho-education is essential. Meager says: “It sort of becomes a vicious cycle for men, because they don’t understand why talking to someone would help them feel better, so they often feel therapy is a waste of time. It is important for mental health practitioners to dedicate time to explaining the theoretical models and evidence based techniques used in therapy, maybe even ask them to do some research before they arrive. Not so much for women, but men like to understand the technicalities of how and why something works the way it does. Once this is understood, they become more open to giving it a try, and are then usually astonished at how much better they feel.”
Depression is an illness, and like any other illness can be treated. Male mental health is in a crisis and it is vital that we stop the rate of men taking their own lives each year, from rising. So come on guys, it’s time to talk and you’d be surprised at how many of us are willing to listen.
– If you suspect that you or someone you love is depressed and in danger of hurting themselves or someone else, please contact a GP or a national helpline immediately.
By Lutfiye Salih