Seeing the Masculinity in Depressed Men…

Fields, A., & Cochran, S. (2010). Men and Depression: Current Perspectives for Health Care Professionals American Journal of Lifestyle Medicine DOI: 10.1177/1559827610378347

There is a theory out there that depression in men is much more common than we can currently ascertain and that the personal, interpersonal, social and economic costs of this hidden epidemic are astronomical (Fields & Cochran, 2010, n.pag.). The massive gap between theory and fact is indeed largely occupied by the presumed reluctance of most men to seek help for any health-related problem, physical but more especially emotional, since to so cede to another person’s wisdom is an affront to masculine ideals. Further, fessing up to feeling a bit fagged out is what women and pewfs do, and so should be avoided at all costs. The script goes that ‘real men’ silently tough out their troubles with gall, gusto and a pint or two of Guinness, for good measure (2010).

Yes, we all know that ‘[m]en are expected to be stoic, independent, and capable of handling their own problems’ (2010). We also know that men are supposed to suck up any emotions that might make them appear ‘unmanly’ (2010), seemingly vulnerable emotions that include the textbook symptoms of depression: sadness, hopelessness, and worthlessness. Moreover, at an even more fundamental level, too many men are incapable of finding comfort in the arms of someone who can love and care for them when they most desperately need it. How many men I have counselled whose depression remained a closely guarded secret from the one person who might best respond to their suffering. That is, their partner…

Fields and Cochran (2010) concede here that yet another reason why men might be so reluctant to fess up to feeling depressed is that the standard, pharmacological treatment is so often much worse than the disease. After all, so-called ‘second generation’ anti-depressants come with some pretty hardcore baggage (weight gain, hair loss, impotence, etc.) (2010). Telling a man who is already feeling like total shite that he might soon be bald, fat and no longer able to get a stiffy is, I would suggest, hardly conducive to treatment uptake, let alone compliance…

…expectations on men to perform sexually raise serious considerations for the use of many antidepressant medications…which have side effects impairing sexual functioning’ (2010).

Where the authors (2010) flourish is in challenging health service providers to question their own practice orthodoxy when working with men who might be depressed…

Do I interpret symptoms differently in male versus female patients?’

Do I make different attributions about a patient’s complaint based on gender?’ (2010).

Somewhat radically, they call on health service providers to explore with male clients, what those clients think about ordinarily muted topics like emotional expressivity, ‘family and cultural norms’ (2010) and help-seeking behaviours. While such a strategy, unfortunately, precludes those depressed men who never make contact with health service providers, it at least offers an enlightened alternative to the usual mantra, ‘get a grip, and get on with it!’

One of the critical flaws of assessing mental ill health according to strict diagnostic criteria (2010) is that we automatically exclude the contextual complexity that characterises why any particular man might be feeling low, down or absolutely crushed. By agitating health service providers to inquire and think about if not entirely ‘see’ that complexity, Fields and Cochran (2010) move us forward, albeit slowly and incrementally. As I say, with stunningly monotonous repetition, depression in men rarely springs from the ether. Rather, it stems from lived experience past and present, maladaptive coping strategies and onerous obligations to ‘be a man’, even when you might be feeling completely washed out. ‘Healing’ depression in men relies upon addressing the aforementioned issues and not, as is common practice, to conceptualise such depression as an isolated, biochemical disorder.

To their credit, Fields and Cochran (2010) mention the important role that counselling can play in alleviating the symptoms of depression in men, charting as they do the ‘implications for use with men’ of several popular psychotherapeutic approaches (behaviour therapy, cognitive-behavioural therapy, interpersonal psychotherapy, psychodynamic or psychoanalytic therapy and humanistic or existential therapy). For example, psychodynamic or psychoanalytic therapy offers men who are depressed the opportunity to safely explore their attachment trauma issues, to appropriately grieve for any broken or non-existent attachments with their primary caregivers, to form positive attachments with their therapists and thus, to learn that loving relationships with their partners and significant others are truly possible…

Still, with all the barriers that exist to any man rocking up to talk with a counsellor, noting that primary prevention is always preferable to later cure, the best intervention has to be teaching boys, teenage boys and men that it is okay to experience a range of emotions and that is okay to talk with family and signficant others about those emotions…

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