Male-Type Depression: The Guy Who Doesn’tLook Depressed

In addition to the patterns of typical depression described in the previous chapter, we now know about a pattern of depressive experiences and behaviors that can only be properly labeled as “male-type depression.” This is depression that really looks different in men than in women. In this pattern, men do not usually report sadness, but they do report feeling irritable or tremendously fatigued. They don’t have a name for the feelings, but there’s a sense of being dead inside.

Something is missing. They feel restless, agitated, and unsatisfiable. They lose their vitality. Vague, persistent physical symptoms show how up, like headaches, mysterious pain, and insomnia. These men often attempt to “self-medicate” with potentially addictive behaviors like alcohol or drug use, gambling, sexual affairs, workaholism, and reckless physical risk taking. In typical male fashion, they act out rather than turn within. And, most disturbingly for you, they blame others for their vague feelings of unhappiness and for their bad moods.

MALE-TYPE DEPRESSION DEFINED

To put it very simply, women tend to think and process their feelings when they are depressed, and men tend to act. A man who takes action in the face of depression can either be extremely adaptive (such as going out to look for a job if he is feeling depressed about being unemployed) or extremely maladaptive (such as picking a fight and getting drunk to escape feeling bad about himself). Research studies report that when women describe what they actually do when they are depressed, they say, “I try to find out why I feel the way I do,” or “I try to analyze my mood” (Nolen-Hoeksema 1993). For men, the patterns are typically quite different. Most men report that they turn to an activity they enjoy or simply decide to distract themselves from the bad feelings: “I decide not to concern myself with my mood.” Of course, many people (especially men) are likely to respond with “What do you mean, depressed?”

Seligman concludes that “men and women experience mild depression at the same rate, but in women, who dwell on the state, the mild depression escalates; men, on the other hand, dissolve the state by distracting themselves, by action or perhaps by drinking it away” (1998). While distraction can come in very handy, this particularly male pattern of avoiding uncomfortable emotional states often leads to avoidance, denial, minimization, and acting out. The distress is there, but it remains unnamed and unclaimed.

This reluctance to face up to depression makes life especially difficult for people like me, who are trying to help men get through it, and for people like you, who have to live with it. Many researchers and theorists who focus on male depression syndrome have tried to identify the central patterns that characterize this long-standing but only recently understood condition (Pollack 1998a; Real, 1997). These patterns cluster into four main categories of behavior patterns: discontent with self, antagonism and blame, exaggerated behavior, avoidance and escape. Please lease note that some of these patterns set the stage for one or more of the other ones. And it is important to remember that these patterns might overlap with more traditional symptoms usually seen in typical overt depression (like despondency, pessimism, low self-esteem, sleep and appetite disturbances, etc.). But they are just as likely to stand on their own: desperate attempts to fend off the core, underlying, unnamed, unacceptable depression.

DISCONTENT WITH SELF

One of the primary features you are likely to see in your partner’s male-type depression is a profound unhappiness with himself. He is likely to display signs of the following patterns.

Harsh Self-Criticism

While a moderate dose of self-criticism comes in very handy for all of us, excessive levels corrupt good judgment.

Paul had been married to Celine for twenty years. He was fifteen years older than she; they were sixty-four and forty-nine when they first came into my office, demoralized by several years of arguing, distress, and alienation from each other. Paul had been a successful attorney until a few years earlier, when hen he had a mild stroke that slowed him down considerably. His mood and self-image, never particularly solid to begin with, crashed with the stroke and the resultant anxiety, lifestyle changes, and fears about the future.

Celine was vibrant, energetic, and very emotional. She watched as her husband’s mood and energy deteriorated right before her eyes. He ruminated about his failures as a provider or protector. She alternately was as patient and enraged by his increased recklessness with business investments and extravagant spending. Two years earlier, he had made a disastrous business investment with an irresponsible and exploitative partner whom she had warned Paul about. This history made Celine feel like she couldn’t trust Paul, which further undermined their relationship.

As Paul withdrew, paralyzed by his own shame and self-criticism, Celine became more emotional and demanding of his time, his attention, and his common sense. She looked and felt crazier and crazier.

Shamed for Feeling Depressed

Many men, despite their increasing internal distress, feel shamed not only by their perceived failures, but by the concept of being depressed.

I worked with Paul and Celine as a couple for a few months without making much progress. In the sessions, Paul adamantly denied that he was depressed and that his behavior patterns were anything to worry about. He stiffened when either of us even hinted at the possibility that he was suffering from the “D-word.” Paul insisted that everything was going to be just fine if everyone would just leave him alone. His moods and behavior said otherwise, of course, but it was clear that the very possibility that he might be a “victim of depression” or “suffering from depression” or “weakened bydepression” added an unbearable component of diminished masculinity to his is self-image. Meanwhile, Celine pleaded. Celine was patient. Celine was angry. One day Celine called me in tears, saying, “Paul told me he wants a divorce! He won’t say why. He has as packed up his bags and moved out, and he won’t talk to me.” A few days later, Paul told Celine, “I just want to spare you having to deal with me. I want to release you because pretty soon I’m going to be drooling in a wheelchair and you need to live your life.”

Paul was shamed by his self-image of being a failure as a husband. He felt like he was losing at the game of life. But he couldn’t talk about it. He couldn’t label it for what it was. He couldn’t call it temporary, or based on circumstances, or something that did not overtake his entire personality or self-worth. He could only run. And, at one point when I tried to empathize with his life situation by suggesting that he was depressed and could benefit from antidepressant medication, he scoffed and never ever returned.

Imaginary Crimes

Sometimes the source of shame-based depression is the experience of unconscious guilt. According to control-mastery theory, also known as imaginary crimes, children often grow up believing that they have committed some emotional crime against their family or that they are at risk for doing so (Weiss and Sampson 1986; Engel and Ferguson 1990). The perception of having committed these crimes leads them to feel shame. And shame, as we know, rarely leads to anything good. More often, shame generates rage, projection of blame, depression, self-destructive behavior, and defensive reactions.

Deon, a man with a tragic past, told me this story of his imaginary crimes:

When I was little, I desperately tried to save my mother as she fought off the cancer that finally killed her. She lasted four years. I ended up with this script that said, “You really have to help fix this woman in your life.” Now, in my relationships, I’ve ended up choosing wounded women who needed a lot of help, and kept trying to fix them. But I also kept getting mad at them because they would not get fixed. And they have always complained because I seemed moody, unhappy, and unsatisfiable. The sad thing is,, they were right.

The crimes referred to here are truly imaginary, because most reasonable observers would say that it is not fair for the child to take on the burden of guilt in this situation. Deon’s depression and sense of failure haunted all his attempts at future relationships.

ANTAGONISM AND BLAME OF OTHERS

The covert, underlying depression that these men experience, when unnamed and unclaimed, often leads down a dangerous path of blame. The depression feels so fundamentally unmasculine and threatening that it must be defended against at all costs. This spells trouble for those close to these men.

Demanding Respect from Others

Take Stuart as an example of this tricky dynamic. Stuart was a client of mine who brought his family in because of all the problems he and his wife were having with their kids. Stuart was in his late forties and had a history of depression, which he’d treated by taking Prozac off and on for several years. Stuart had lost a leg during combat in Vietnam and had struggled for decades with VA hospitals and clinics trying to find the right prosthesis. He worked in the administration of a small business and was pretty low on the he totem pole. His bouts of depression were marked with profound feelings of helplessness and powerlessness, which he usually masked by trying to take bold actions. In one session, Stuart and his family talked about the drama of the past week. Stuart had d come home to find his daughter, Karen, in tears, wailing (as only a thirteen-year-old girl can wail) about how an alleged friend had spread rumors of her sexual behavior at a party. Stuart – being a good dad who ho cared about his daughter and couldn’t bear to see her in such pain – sprang into action. He single-handedly decided that the solution was to call the other girl’s mother and insist that her daughter apologize to Karen and tell the other kids that she just made the story up. Stuart’s daughter’s response to this was a resounding “No!” When his wife politely said that she didn’t think this was a good plan, Stuart went ballistic. He demanded that they follow his plan and insisted that, if they hey didn’t, it meant that he was not a valuable or respected member of the he family. His is only recourse then would be to leave. When no one responded, perhaps too stunned to know what to say, Stuart packed his bags and left. He spent the night at a motel and then came back the next morning feeling stupid.

In the family session, Stuart was able to articulate what had set off this tantrum: “I felt like I had to take charge. Nobody listens to me anymore! I started thinking that I would be unloved and disrespected if I couldn’t make a difference here. It was all about feeling powerless. I guess I kind of forgot that we were all feeling powerless. We were all inthis together.”

Stuart, feeling powerless without the capacity to name it and claim it, could only respond by “puffing up.” Even good men with good values who deeply care about their kids and family can mismanage their reactions to everyday family events when they are struggling with underlying or covert depression. They tend to get tripped up by emotions that they can’t handle very well. They feel helpless and powerless, which is constitutionally intolerable for most of us raised as boys and men. So they insist on implanting solutions and react impatiently and even aggressively when their solutions aren’t respected or implemented, or if they prove to be ineffective.

As author Terrence Real says, “The pattern in males of moving from the helpless, depressed, ‘one down’ position to a transfigured, grandiose, ‘one up’ position has become one of the most powerful and ubiquitous narratives of our time” (1997, 68).

Rick, a successful businessman who had always complained of restlessness and dissatisfaction with his life, was spending time with his wife and her family. He had always felt devalued and disrespected by his in-laws, and on this occasion (not unlike many others) he desperately tried to inflate and impress. He name-dropped about important people he knew, relentlessly steered the conversation back to his material success, and dispensed unsolicited financial advice. His wife was horrified and later told him he had acted like a fool. In short, Rick’s depressive view of himself had been activated, prompting him to go on the offensive with an obvious and embarrassing ploy to gain respect.

Increased Antagonism: The Best DefenseIs a Good Offense

A man who is struggling with depression, particularly this form of covert male depression, lives in dread of experiencing even more of it. At some level, usually not consciously, he recognizes that his capacity to handle more dysphoria is limited. His emotional survival depends on fending off experiences that will make him feel worse about himself or more hopeless about the future. In these situations, the best defenseseems like a good offense. When he smells danger – as in situations that might activate some feeling of depression – he proactively goes on the attack.

My client Antonio had a history of alcohol abuse in his long-standing marriage. He had recently been busted by his wife for cheating on her. They came this close to divorce, but she agreed to try to work on the marriage as long as he took responsibility for his long-standing depression, substance abuse, and occasional infidelity. Antonio had hit rock bottom. He was as deeply depressed and anguished about the damage he had done and the impending losses he faced if he did not shape up. But in a classic effort to avoid even more feelings of worthlessness and guilt, Antonio managed to make the situation his wife’s fault. When she would bring up her fears and anger, Antonio found ways to make her feel bad about bringing up the subject. It was always the wrong timing, or the wrong tone of voice, or excessively repetitious. Why? Because her pain reminded him of his depression and the helplessness he felt to undo the damage. Instead, he attacked her. Because this strong, bold, powerful man was scared by his own depression, he felt compelled to strike out at the victim of his misbehavior.

Attacking When Hurt

Sometimes the covertly depressed man will generate conflicts with his partner that seem to come out of nowhere – although they usually can be traced to some way that he has felt hurt or threatened.

In the movie Good Will Hunting, the main character is a young man named Will who is haunted by an abusive past and a terror of being exposed as “damaged goods.” When the new love of his life, the first woman whom he has ever begun to open up to and trust, invites him to move to California with her, he goes rigid – and eventually ballistic.

In terror that hat he will trust her and then be rejected because of his profound flaws and inadequacies, he coldly attacks her. This offense is capped by the ultimate blow of the depressed man who goes on the offensive: “I don’t love you.” On the surface, Will shows nothing that we would typically describe as signs of depression, but he is the poster child for the male-type depression pattern of a man going on the offensive when he feels like he is on the defensive.

Suspicion and Mistrust

Another form of blaming and antagonistic behavior is expressed through suspiciousness and mistrust. Locked into these patterns of covert, unnamed depression, your partner may feel all-too-easily threatened and insecure. Instead of talking about it or trying to make sense of it, he attacks and blames and retaliates. Shakespeare’s Othello, an insecure and vulnerable man, lives in dread that his is wife, Desdemona, will betray him. With nasty assistance from a scheming friend, Othello starts to think of Desdemona as someone who ho is untrustworthy. Then everything she does (her handkerchief suspiciously missing, ian overheard conversation that could imply her infidelity) just further serves to confirm what he has come to believe about her. There is no possibility of doubt; he cuts her no slack. His profound pessimism about the he inevitability that he will be rejected and betrayed leads him to see it where it does not exist in a futile attempt to ward off the even greater injury of being surprised and crushed even further. This pattern, like many other interpersonal patterns of the defended depressed man, generates a self-fulfilling prophecy of rejection and betrayal. But it is important to understand where it all comes from, because many men actually are capable of changing this pattern when they learn to recognize it and its consequences. And many of you can find ways to help him make these changes if you understand it, too.

EXAGGERATED BEHAVIOR

Hidden depression in men, even if it only barely leaks through into consciousness, presents a profound and intolerable threat to traditional masculinity. In response, many men unconsciously turn to exaggerated, hypermasculine behaviors. It’s as if they have to consistently prove to themselves and everyone else that they’re really not depressed, not weak, not vulnerable – not emasculated. It’s as if they are desperately performing masculinity so they can scoff at the notion of depression, in effect saying to everyone, “Look at me. Do I look like a guy who’s depressed?”

Although many people of both genders live interesting and exciting lives by taking risks and seeking out stimulating life experiences, a covertly depressed guy will often turn desperately to excessively stimulating experiences to try to shock himself out of his depression. He hates feeling bored. He hates feeling down. He hates feeling dull and empty and deadened inside. So he unconsciously administers electro-convulsive therapy to himself by engaging in high stimulation experiences.

Substance Abuse

For some men, this shows up in an obvious way: substance abuse. Depressed men are quite likely to drink to excess. And they are especially attracted to stimulants like cocaine, crystal methedrine, or Ritalin. This is a form of self-medication and, unfortunately, it sort of works. These drugs provide a buffer to the dysphoria so that, following the essential principles of learning theory, the reinforcing effect leads him back to repeat the same behaviors, despite the long-term cost. When he is depressed enough, just like when he is in chronic pain, he can get pretty desperate, and he is quite susceptible to trying anything to convince himself that what he is doing is justifiable and good.

Anger Addiction

Current brain research adds another dimension to why someone would engage in a pattern of blaming, angry, and sometimes explosive behavior: his body and brain may be getting a real charge from it.

What we now know more clearly than ever before is that anger can make someone feel powerful – not just psychologically, but neurochemically. It is, for many men, a magic potion that can lift them out of pain, self-doubt, and depression.

First of all, the brain secretes norepinephrine when a person feels provoked. Norepinephrine produces an analgesic-like effect: it deadens pain. To make the cocktail even more potent, the angry brain also secretes the amphetamine-like hormone epinephrine. This allows the depressed man to experience a surge of energy throughout his body. This accounts for the adrenaline rush that so many people reportfeeling during a sudden attack of anger.

People who are drawn to angry outbursts and other temper explosions often have an understimulated nervous system (Foreman 2000). In these cases, outbursts may actually provide the rush of energy that jolts the brain to more normal functioning. Has the man in your life ever gone out looking for a fight? Some men experience this walkinginto a bar or a party. And others arrive home and walk in the door agitated and restless. He sees you or the kids and Mr. Hyde emerges. He is desperately searching for something to be pissed off about. There’s always something. And when he finds the excuse he is looking for, he blows up. He is addicted to anger, because it lifts him (but only temporarily) out of depression and gives him the jolt of energy he craves. It is his cocaine. And it always seems like it is justified and someone else’s fault.

Too Much Sex

Sex can provide the same effect as anger, and can likewise mask the underlying engine that generates the urge: covert depression. For instance, George came into my office and told me the story of his compulsive philandering. He had been married to Andrea for five years, the last two of which had been colored by a torrid affair he had conducted with a sales rep who worked at his business: My escapades with her were so hot, I would sneak out any chance I could get. I would get up early in the morning, tell Andrea I was going to the gym, and sneak over for a quickie. Finally, my lover got tired of it. She knew I was trying to use her to self-medicate. She told me that it was too much pressure to be responsible for my unhappiness.

That’s it in a nutshell. George had turned over the responsibility for managing his unhappiness to his sexual escapades with his lover. Now, months after the affair was over, months after his wife found out, it suddenly dawned on him: I realize now that I have been depressed, off and on, for years. And I keep turning to other people and activities to bail me out. I think that’s why I got married in the first place, for the rush, and why I lost interest in the marriage. I wasn’t getting the endorphin rush anymore, and I needed to get it somewhere.

It may be difficult to think of highly active, risk-taking, angry, sexually active men as being depressed. But many are. And when they can recognize that and take responsibility for it, then they – and the relationship they are in – might actually get real.

AVOIDANCE AND ESCAPE

When you know that your husband or boyfriend is acting erratically, withdrawing emotionally, or making crummy decisions to prove to others that he is a strong and independent person – in other words, when you know that he is going through male-type depression – you are probably observing a pattern of behavior designed to avoid and/or escape feeling bad.

Now, there’s certainly nothing inherently wrong with finding a way to avoid or escape feeling bad. It can represent a very resourceful set of skills. But when your partner is feeling depressed, anxious, alienated, lethargic, unmotivated, and pessimistic, he may have a vague awareness that something disturbing is taking place within and feel woefully ill-equipped to recognize it, name it, express it, and productively deal with it. Or at least live with it until it passes. This sets the stage for unhealthy avoidance and escape. Avoidance patterns are evident when he carefully discerns situations that he does not want to find himself in and carves out a lifestyle engineered to avoid them. Psychologically, this makes perfect sense. Who wants to put themselves in a situation that is likely to make them feel bad? Except that the life restrictions we are talking about here are crippling.

Defensive Avoidance

Some men systematically – and often unconsciously – refuse to put themselves in situations where they may get hurt or suffer loss. Will Hunting (in the movie Good Will Hunting) has carefully crafted such a life. As I described earlier, he turns down the opportunity to move to California with a terrific young woman who loves him. In the big blowout argument with his girlfriend, this deeply (covertly) depressed man, who masks all his unhappiness with activity, bravado, and emotional distancing, screams out at her. He accuses her of just wanting to have a fling with him until she he meets somebody else more worthy, someone from her social class. It’s clear to the audience that he’s acting nuts. And in a way, it is nuts, because he’s giving up the very thing he wants but of dread of putting too much trust in another person and then getting devastated by the eventual rejection.

Sadness Phobia

Part of what handicaps Will Hunting is that he is terrified of identifying, naming, acknowledging, and expressing his profound sadness and pain. He cannot grieve for what he has lost and how he has suffered. So, in classic guy style, he sucks it up and projects a tough and impenetrable exterior. The driving force behind these behaviors is his desperation to avoid the possibility of acknowledging emotional pain. When he is able to do this, his male-type depression loosens its grip on him and he develops at least the possibility of a more authentic and intimate relationship.

Escape Behaviors

Many depressed men are desperate to escape emotionally uncomfortable situations. One of the most common ways they remove themselves is emotional zoning out, or what author Terrence Real calls the “I Don’t Want to Talk About It” syndrome (1997). A little of this is pretty normal. A lot of it signals an underlying depression and anxiety that can destroy the relationship.

Mikhail’s marriage was deteriorating because he kept shutting down emotionally whenever his wife tried to talk to him about anything that could possibly make him feel bad. As Mikhail tried to make sense of this, he recalled his experience growing up with his dad:

I can remember so clearly being called into my father’s den. It was always filled with smoke. He sat there in that big avocado-green chair, and I was always in that brown chair where I had to sit up very straight. And he would lay into me. Lecture me. Put me down. It would go on and on for what seemed like hours. I just zoned out. And when teachers in school would go into lecture mode, I would zone out the same way. It felt like a wall kicking into place that insulated me from what I was hearing. And the same thing keeps happening with Rosie. It just drives her nuts and makes everything worse.

But zoning out isn’t the only way depressed men escape. These behaviors run the gamut from overworking to drinking, surfing the Internet, to flirting or having affairs. For example, my client Lane told me about how defeated he felt in his relationship with his wife:

Cara is always telling me that she is tired of me rejecting her anddishonoring her. She tells me I’m just a “taker.” So what do I do? I just work. I drink too much. I zone out on the Internet. I try to occupy my time without too much thought. I don’t know what to do, so I do nothing. I can’t do anything right.

The drive for emotional self-protection makes sense psychologically. But it is corrosive to the self and ultimately corrosive to the relationship.

EXERCISE: Is Your PartnerSecretly Depressed?

Below is a questionnaire for you to fill out to help you assess whether the man in your life is suffering from male-type depression. In the right-hand column, score 0 if the item is not a problem, 1 if it is something of a problem, and 2 if it is very noticeable or serious.

Please note that a few of the items on this inventory are similar to the depression questionnaire in chapter 1. These two patterns of male depression are not completely separate – they share some fundamental features of depression, no matter the differences in how these problems show up behaviorally.

Is Your Partner Secretly Depressed? Score 0, 1, or 2
DISCONTENT WITH SELF
1. Does he subject himself to very harsh self-criticism?
2. Does he seem very sensitive to the possibility of being shamed or looking bad?
3. Does he have a very limited vocabulary to describe his feelings?
4. Does he avoid putting himself in situations where it might appear that he is failing?

ANTAGONISM AND BLAME OF OTHERS
5. Does he blame others for his bad moods?
6. Does he demand respect without behaving so as to earn respect?
7. Does he think all of his problems would end if only you would behave differently?
8. Is he guarded and suspicious?
9. Does he have frequent angry outbursts?

EXAGGERATED BEHAVIOR
10. Does he crave sex desperately?
11. Is he (or has he been) having an affair?
12. Does he abuse substances, TV, video games, or the Internet to self-medicate?
13. Does he engage in high-risk behaviors (driving fast, inappropriate flirting, reckless business ventures, etc.)?
14. Is he a workaholic?
15. Is he compulsive about time and order?
16. Is he perfectionistic?

AVOIDANCE AND ESCAPE
17. Does he have difficulty grieving when he suffers a loss or disappointment?
18. Does he suffer from the “I Don’t Want to Talk About It” syndrome? Does he express feelings of worthlessness? Does he seem especially discouraged about the future?
19. Does he shy away from hearing about your problems because they might bring him down? Does he complain that everything is going wrong no matter how hard he’s trying?
20. Does he insist that every everything is okay, even when it is obvious that it’s not?

SCORE

This is not a scientific tool for proper diagnosis, so I won’t offer an absolute cutoff for determining male-type depression. But the exercise should give you a guideline to help you determine if your partner is covertly depressed. If you discover that he is, you can help him deal with this – or at least you can make more sense of what you are going through and cope with it better. Any score of 10 or above suggests male-type depression, and anything over 20 should serve as a major red flag. Please remember that this measures only one cluster of depression symptoms – male-type depression or covert depression – and the more familiar signs of depression are addressed in chapter 1.

SUMMARY

Male-type depression represents a pattern of male depression that doesn’t usually fit our traditional picture of what a depressed person is supposed to look like. We see four basic clusters of behavior patterns: discontent with self, antagonism and blame others, exaggerated behavior, and avoidance and escape. These patterns are all generated by the difficulty that many men have in identifying their internal experiences and in dealing with the negative self-image associated with depression. The more you know about these signs of underlying depression, the more you can plan how to respond.

 
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