Words By Adri Prinsloo, Department of Psychology, University of Pretoria

Men do become depressed. This is a seemingly obvious statement. What is less well known to men, health care professionals and the public is that many more men are depressed than we know.

On 30 March 2017, the World Health Organisation made this startling announcement: depression is now the primary cause of disability and ill health worldwide. Moreover, depression can lead to suicide and somewhere in the world, a person dies every 40 seconds in this way. In many countries, including South Africa, about four times more men die by suicide than women. Yet women are four times more likely to be diagnosed with depression. This discrepancy suggests that there are more men who are depressed than statistics show.

There are several reasons we may think of men as unlikely candidates for depression. Cultural expectations that “big boys don’t cry”, that men should keep a firm grip on their emotions, be tough, able and always coping with life’s demands is powerful in shaping expectations. For instance, like most people health care professionals too are prone to seeing depression as a “female disorder” hence missing signs of depression in men. In addition, men themselves tend to be less adept at recognizing symptoms of depression than women do.

It is becoming increasingly evident that depression in men may not look exactly the same as in women. Whilst some men do experience the classic symptoms such as a loss of interest and pleasure, energy loss, concentration problems and feelings of worthlessness or guilt, they also experience and express additional symptoms or “depressive equivalents”. 

For instance, men may “do depression” differently than women. This means that they use avoidance strategies such as spending a lot of time at work, watching television or doing all manner of things in order not to think about their problems. Risky behaviours such as having an affair and using drugs or alcohol to self-medicate are also often used as means to dull or escape emotional pain. These strategies are of course mostly ineffective and often exacerbate the problem; alcohol does not alleviate depression and overworking or having an affair are mostly damaging to relationships.

Some men may also “feel depression” differently than women do. Men are more likely to be aware of depression’s physical symptoms such as losing weight, difficulty with sleeping or feeling tired. Depressed men may experience intense irritation or anger, which may escalate into aggression. For some men, it may be far easier to be angry or hurtful than to show sadness or despair because these behaviours are considered to be manlier. Women, on the other hand, are more prone to feeling sad and worthless.

All these signs, in essence, means that some depressed men try very hard to hide depression from others and themselves. This is why it is thought that men “mask” depression. By implication, depression is often missed in men.

Without acknowledgment and diagnoses, there is no treatment. Whilst health care practitioners are becoming more sensitive to how men express and experience depression, it may persist to be difficult for men to recognise and acknowledge it. Asking for help is hard for most men. It signals weakness and vulnerability that are seen as unmanly. A man may also feel that he will be stigmatized as weak and unable to cope if he does seek help.

But there are men who are manning up to depression. Bruce Springsteen openly admitted that depression has led him to seek professional help for the past 30 years. Abraham Lincoln, Winston Churchill, Jim Carrey, Leonard Cohen and even Buzz Aldrin have all experienced depression. There is no insurance against depression. Fame, fortune, and success are no more successful in protecting a man against depression than poverty and disappointments. Like women, men may even experience depression before or after the birth of a child or in the case of a partner’s miscarriage.

Depression is highly treatable by means of medication, psychotherapy or both. The first step though is to recognize it as depression.

Depression is more than just a dip in mood. It distorts the past into a terrible history, darkens the future and throttles today. It profoundly affects the way you see the world, others, and yourself – the way you live and love in the world.

Adri Prinsloo is a clinical psychologist at the Department of Psychology, University of Pretoria. She is currently completing a doctoral thesis on the ways men experience and express depression and how health care professionals can best assist these men.

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