Soon after I created this website in 1995, I wrote an article about women and depression. At that time it was believed that women suffer from depression about twice as often as men do, although no one was sure why. Some hypotheses posed biological reasons, such as greater incidence of sexual assault and abuse and role in society.
I was never completely comfortable with the idea that more women than men were depressed. It didn’t seem to make sense to me. For one thing, most of the famous people with depression who came to mind (for me, at least) were men. Winston Churchill, Mike Wallace, Abraham Lincoln, Robin Williams and Terry Bradshaw, to name a few. Not that famous women didn’t come to mind, but I couldn’t come up with a much larger number of┬ámore women than men.
The other thing that bothered me, as it always does, is that there was no clear reason why women would experience depression so much more than men. I admit that I like to have reasons for things; I don’t want there to be unknowns when it comes to something like depression. And all the explanations for the disparity were vague at best.┬áHormones, sure. Societal issues, maybe. But nothing that accounted for this purportedly large difference in the numbers between men and women.
And then there was the question of reporting. Some medical professionals suspected that the reason for the large gap was not that fewer men were depressed, but that they had more trouble talking to their doctors about mental or emotional problems. Women tend to be more comfortable asking a doctor about a medical concern, let alone admitting to mental health issues. But since there were no studies to support this hypothesis, the idea didn’t gain much of a foothold until recently.
In the last few years, attitudes have begun to change about the prevalance of depression in men with the advent of some new ideas. The mental health community is beginning to use these to challenge the long-standing beliefs about men and depression.
The most important new idea, in my mind, is that depression actually manifests itself differently in men than in women. While women tend to exhibit the classic symptoms of sadness and loss of interest in previously enjoyed activities, men tend to more frequently exhibit less classic symptoms like anger, irritability and abuse of alcohol.
Because men’s depressive symptoms don’t fit the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the bible for mental health professionals, it’s very possible that many men who should be diagnosed with depression are not.
Along with the failure of the medical community to recognize the depression symptoms that are largely unique to men, there are some other barriers to diagnosis of depression in men:
- Cultural expectations can compel men to mask their depression. Expressing emotions is seen as a feminine trait in the American culture.
- Men use different language to express their depression. Men are much more likely to say that they’re “stressed” or “burnt out” than they’re “depressed.” A man I know would insist after a weekend of binge drinking that he was just “in a funk.”
- Instead of seeking treatment, men are more likely than women to cope with their depression with alcohol and drug abuse, risk-taking behavior or workaholism. Since medical professionals and the public at large don’t tend to associate the last two behaviors with depression, this is probably a factor in why depression in men is less frequently diagnosed.
- According to the Centers for Disease Control and Prevention men are less likely than women to seek help for any medical problem.
It seems entirely plausible that instead of men suffering from depression much less frequently than women, they are in fact underdiagnosed.
And they need to be diagnosed. We’re now beginning to realize that the myth that men don’t suffer from depression as often as women is not only far off the mark, but it’s an extremely dangerous one. According to the Centers for Disease Control and Prevention (CDC) men are four times more likely than women to die from suicide; it’s the eighth leading cause of death for men in the U.S.
Unlike some, I don’t believe that there should be a separate category for male depression, but I think that the current criteria should be expanded to include the symptoms that men are more likely to have.
Another thing to consider is that human personalities, male and female, exist on a continuum. Who’s to say that there aren’t also some women whose depression is being missed because their symptoms aren’t classic?
Fortunately, medical professionals can use their own judgement and not rely exclusively on the DSM IV for diagnosis. Hopefully, more and more of them will do this till the depression criteria are updated to recognize that yes, men and women are different.