Men's Machismo Could Be Depression
Buffalo News - November 25, 2005
You might call it melancholy on steroids -- a muscular mixture of fast-driving, heavy drinking, hard-charging cussedness. For perhaps 3 million American men yearly, that?s the plotline for depression.
For almost 24,000 men yearly, the final scene is suicide. Often, there is no cry for help, no river of tears, no abyss of sadness. Just a violent, tragic bolt from the blue.
It is a refrain heard so commonly by psychologists and psychiatrists that it could be the opening to an inside-the- profession joke: "This guy trudges into my office, collapses into the chair and says, ?My wife/partner/friend sent me. She says I?m depressed.? "
The man seldom believes it himself. But as the symptoms are coaxed from the patient -- changes in appetite, fitful sleep, low energy -- resistance often drops away. And a willingness to get treatment can emerge.
In the United States, a man is four times more likely than a woman to commit suicide, according to government statistics. Yet, he is only half as likely to be diagnosed with depression. That stark disconnect underscores a simple fact about depression in men: It often does not look like the mixture of sadness, guilt and withdrawal that dominates diagnostic descriptions and popular perception of the disease. As a result, a man?s depression is often missed -- by loved ones, by physicians, by the sufferer himself.
The costs are steep: in lives hobbled, jobs lost, relationships ruined. Some professionals even tally the toll in prison terms, substance-abuse statistics and shattered communities.
But today the diagnosis of depression is in the midst of a long- overdue makeover, as medical and mental health professionals have come to recognize that in at least half of depressed men, the recognizable litany of symptoms don?t really fit.
Some depressed men may be plagued by impotence and loss of sexual interest, but others may become wildly promiscuous. Many complain of depression?s physical symptoms -- sleep troubles, fatigue, headaches or stomach distress -- without ever discerning their psychological source. Compared to women suffering depression, depressed men are more likely to behave recklessly, drink heavily or take drugs, drive fast or seek out confrontation.
Instead of acting like they are filled with self-doubt, depressed men may bully and bluster and accuse those around them of failing them. For many men, anger -- a masculine emotion that one "manages" rather than succumbs to -- is a mask for deep mental anguish.
"That?s their way of weeping," says psychologist William Pollack, director of the Centers for Men and Young Men at McLean Hospital in suburban Boston and an expert on depression in men.
Pollack and a small but growing number of depression experts say it?s time for the mental health profession to expand its definition of depression so it is better recognized in men. They are pushing for a new category of depression -- Pollack calls it "male-based depression" -- to be incorporated into the new "Diagnostic and Statistical Manual," the bible of the mental health profession that is being updated.
In the worlds of business, sports and politics, a few influential sufferers have broken their silence in recent years, helping to put a male face on the disease.
One of them is business mogul Philip E. Burguieres, once the youngest chief executive of a Fortune 500 company. In the early 1990s, Burguieres says he was an outwardly successful workaholic problem-solver. But he never slept more than a few hours at a time - - and inside, worry gnawed at him so furiously, "I almost wanted to peel my skin off," he says.
In 1991, after wrestling for weeks with a particularly intractable business challenge, Burguieres passed out in his office. A psychiatrist bluntly told him he was clinically depressed and prescribed medication, psychotherapy and participation in a mental health support group. Burguieres dismissed the recommendations out of hand.
By 1996, his depression was back with a vengeance, and at age 53 he bowed out as chief executive of an energy services company, citing "health reasons." For almost a year before doing so, he had fantasized obsessively about committing suicide.
But "almost to the day I committed myself, I could fake it," says Burguieres. "I could put on my blue suit and my red tie and look good for a couple of hours, then come home and collapse."
In recent years, Burguieres, now owner of the NFL?s Houston Texans, has spoken to many business groups about his depression. And so many fellow businessmen have confided their own, similar stories that Burguieres believes the disease is "chronic and widespread in the executive office," and growing harder to ignore.
Even physicians and mental health professionals who have come to recognize depression?s unexpected manifestations in men are careful to avoid what psychologist Pollack calls "the D-word" when they first suspect it. Kevin Brown, a Los Angeles family physician, says that with men in general -- and his predominantly black and Hispanic patients in particular -- he reaches for other words to open a conversation about depression.
"I tend to use the words ?under stress? more often than not, and people can definitely relate to that," Brown says. A referral to a mental health counselor or a psychological support group "is definitely almost a no-no," he says, because "there?s usually more machismo or bravado about men?s ability to handle whatever emotional problems they might have."
Brown says that in men who do not appear to have reached a state of crisis, he may first prescribe an antidepressant. Only after a few follow-up visits, when he has gained a patient?s trust, would he suggest counseling. Brown, who is black, suspects that among males in the population he serves, depression is quite common and largely unrecognized. Most of it, he suspects, plays itself out on the streets, in gangs and behind the tinted windows of cars. "I can only guess the numbers of those who do not get help, and I think we see the effects of this in the criminal justice system," he says.
