Real Men Cry: Men & Depression

“A lazy part of us is like a tumbleweed. It doesn’t move on its own. Sometimes it takes a lot of depression to get tumbleweeds moving.”  – Robert Bly, Morning Poems

Growing up the son of a WWII vet, my dad’s parenting style could best be described as minimalist: punishment at his leisure as alcoholics are prone to do; hard, physical labor built character; and praise came from athletic accomplishments like football which prized hitting.

Crying? Only once as a young child. Dad’s reaction? “I’ll give you something to really cry about if you don’t knock it off. Only girls cry!” Looking at him through the eyes of a child, the message was clear: Crying (or any display of sadness) was never to be done again if I wanted his approval (In essence, his love which never came).  As I grew older, he added this maxim: Pain, physical or emotional, was to be endured, if not conquered.

“I Don’t Want To Talk About It”: Guys With Depression

Years ago, 1997 to be exact, I was thinking about writing an article for a lawyer’s magazine about my experiences with depression while practicing law.  I had lunch with a good friend of mine, Bob, who at that time worked in a large litigation firm in New York City.  Since then, Bob has become a federal judge and remains a dear friend.

After we had ordered, I told Bob about my idea to write the article. He sat quietly and listened, looking down at his salad as I spoke.  Finally, he said, “Dan, this is an awful idea.  While noble, why would you expose yourself to the insults some people are going to hurl your way.”  We spoke at length and I finally told my dear friend that I was going to write the article anyway.

male depression

For the first few years after that initial talk, Bob would call me regularly and check in, “How’s it going, Dan? Is everything all right?”  I so appreciated Bob’s loving concern.  More importantly, however, something began to change in our relationship.  Bob eventually disclosed to me that he had had a episode of major depression some years ago and had tried to commit suicide.

It seems to me that my willingness to speak frankly about my depression gave Bob permission to speak about his.

Unfortunately, talking about depression is not easy for most men. They have lots of trouble coming to terms with depression, even when they get treatment. All the more so if they’re a lawyer.

Lawyers aren’t supposed to have problems; we’re supposed to fix them. Most male lawyers I know would rather drop dead than admit that they have problem with depression. I guess the exception to this observation is when the wheels have fallen off for them. Then, and only then, do they recognize (hopefully) that they are suffering from depression and the toll that it is taking on their lives. The consequences for failing to recognize this basic fact can be serious (loss of productivity at work, sleep problems, etc.) or fatal (middle aged lawyers commit suicide at twice the rate of the national average).

Psychologist, Terrance Real, the author of the book, I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, makes the observation that we don’t think of men as depressed. This is so because what we are really thinking about is “overt” depression and more women show signs of that – weeping, a willingness to discuss painful feelings, etc. Men suffer from “covert” depression that expresses itself in addiction, isolation, workaholism, isolation and increased irritability.

“Men are just as feelingful, just as relational, just as connected, just as dependent, just as needy, as women are. Men have been coerced since childhood to forego these relational qualities and skills and squeeze their sense of membership and self-esteem through performance. Girls are taught to filter their sense of self-worth through connection to others, and boys are taught to filter their sense of self-worth through performance. That’s a vulnerable foundation for one’s self-worth,” notes Real.

The excellent website, Men Get Depression, says there are three distinctive signs of male depression:

Pain. 
Depression may show up as physical signs like constant headaches, stomach problems, or pain that doesn’t seem to be from other causes or that doesn’t respond to normal treatments.

Risk Taking. 
Sometimes, depressed men will start taking risks like dangerous sports, compulsive gambling, reckless driving, and casual sex.

Anger. 
Anger can show itself in different ways like road rage, having a short temper, being easily upset by criticism, and even violence.

So often, the first symptom that male lawyers notice that they are slipping is in the performance department. One of the symptoms of clinical depression is difficulty concentrating. This leads to problems in getting work out the door. They may try to hide that their work is slipping – ask for extensions, take much longer to do tasks that were simple and routine in the past. If the problem doesn’t go away, some will seek out help – usually through their family doctor (who distribute 80% of the prescriptions in this country for antidepressant medications). Some will go the extra step of seeing a therapist that they can talk with about their problems.

My therapist used to liken my depression to a caveman camping out of his cave. It took a lot to coax me out of there. Men need to come out of their caves into the light of day where the colors are brighter, others can help them and they can get better.

 

 

Dan’s Top Ten Depression Books

Undoing Depression – Richard O’Connor, Ph.D.

This is the best book I’ve read on depression.  Perhaps it’s more compelling than most books on this subject because Richard O’Connor, a therapist in New York City, has gone through major bouts of depression himself.  Depression has often been compared to heart disease; an illness fueled by complex and interrelated factors: genetic, biochemical, environmental.  In this book, O’Connor focuses on an additional factor often overlooked: our own habits. Unwittingly, we get good at depression.  This book teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to “do” depression. And we can learn how to “undo” it. With a truly holistic approach that synthesizes the best of the many schools of thought about this painful condition, this book offers new hope, and new life, for sufferers of depression.  Go to Dr. O’Connor’s website  

The Noonday Demon – Andrew Solomon

Winner of The National Book Award following its release a decade ago, this is a beautifully written book by depression sufferer, Andrew Solomon.  Drawing on his own struggles with the illness and interviews with fellow sufferers, doctors and scientists, policy makers and politicians, drug designers and philosophers, Solomon reveals the subtle complexities and sheer agony of the disease. With uncommon humanity, candor, wit, and erudition, he not only helps us understand depression, but also the human condition. Go to Andrew Solomon’s website to read a chapter

The Mindful Way through Depression – J. Mark Williams, Ph.D.

Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all.  It seems like every few days, there is a new book or article out on the power of mindfulness. Here, four uniquely qualified experts explain why our usual attempts to “think” our way out of a bad mood or just “snap out of it” lead us deeper into the downward spiral. Through insightful lessons drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to despair, including rumination and self-blame, so you can face life’s challenges with greater resilience. Jon Kabat-Zinn gently and encouragingly narrates the accompanying CD of guided meditations, making this a complete package for anyone seeking to regain a sense of hope and well-being.  Go to a review and summary of this book

Listening to Depression – Lara Honos-Webb, Ph.D.

I first read this book five years ago and was struck by its originality:  depression isn’t just a disease to be fixed with medication and therapy, but a warning signal that our lives are off track and needs to be healed.  In this sense, depression and its painful symptoms is a sort of unwelcome wisdom. Dr. Honos-Webb argues that we too often try to cut off or numb our feelings of depression instead of listening carefully to what they are telling us about our lives. Listening to Depression offers insightful ways to reframe depression as a gift that can help you transform your life for the better.  Go to an interview with Dr. Honos-Webb

Lincoln’s Melancholy – Joshua Wolf Shenk 

I am a little biased here.  I am a lawyer and Lincoln is my hero.  He not only was a great trial lawyer, but also struggled with depression his entire life. Giving shape to the deep depression that pervaded Lincoln’s adult life, Joshua Wolf Shenk’s Lincoln’s Melancholy reveals how this illness influenced both the president’s character and his leadership. Lincoln forged a hard path toward mental health from the time he was a young man. Shenk draws from historical record, interviews with Lincoln scholars, and contemporary research on depression to understand the nature of his unhappiness. In the process, he discovers that the President’s coping strategies—among them, a rich sense of humor and a tendency toward quiet reflection—ultimately helped him to lead the nation through its greatest turmoil.  Go to the author’s excellent website about the book

Unstuck: Your Guide to the Seven-Stage Journey Out of Depression – James S. Gordon, M.D.

One of our country’s most distinguished psychiatrists and a pioneer in integrative medicine, Dr. Gordon believes that depression is not an end point, a disease over which we have no control. It is a sign that our lives are out of balance, that we’re stuck. It’s a wake-up call and the start of a journey that can help us become whole and happy, one that can change and transform our lives. Unstuck is a practical, easy to use guide explaining the seven stages of Dr. Gordon’s approach and the steps we can take to exert control over our own lives and find hope and happiness. Unstuck is designed for anyone who is suffering from depression, from mild subclinical depression (“the blues”) to its severest forms. Go to this PBS television intereview with Dr. Gordon

Unholy Ghosts: Writers on Depression – Nell Casey

The only book of its kind, Unholy Ghost is a unique collection of essays about depression that, in the spirit of noveliest William Styron’s Darkness Visible. Unlike any other memoir of depression, however, Unholy Ghost includes many voices and depicts the most complete portrait of the illness.  With an introduction by Dr. Kay Redfield Jamison, Unholy Ghost allows the bewildering experience of depression to be adequately and beautifully rendered. The twenty-two stories that make up this book will offer solace and enlightenment to all readers.  Go to an excerpt of the book

Depression is Contagious – Michael Yapko, Ph.D.

Dr. Yapko has identified the types of relationship patterns that lead to negative ways of thinking, feeling, and relating to others and culls from the latest findings in neuroscience, social psychology, epidemiology, and genetics to provide a practical, proven plan for developing the skills and insights you need to forge stronger, healthier social connections and enjoy an enriching, interconnected life. While commonly prescribed drugs address some of depression’s symptoms, they cannot change the social factors that cause and perpetuate the disorder. By treating a social condition as though it’s a disease, the problems compound rather than diminish. The foundation for recovery is to build a healthy social life based on understanding what to expect from our relationships, what we should give, and how to relate to and accept others — skills that have been neglected by modern society. Dr. Yapko’s groundbreaking plan of action — filled with skill-building emotional and mental exercises, anecdotes, and illuminating explanations.  Go to an article written by Dr. Yapko about his approach to treating depression

I Don’t Want to Talk About It – Terrence Real

Depression is a silent epidemic in men who hide their condition from family, friends, and themselves to avoid the stigma of depression’s “un-manliness.” Problems that we think of as typically male — difficulty with intimacy, workaholism, alcoholism, abusive behavior, and rage-are really attempts to escape depression. And these escape attempts only hurt the people men love and pass their condition on to their children. Real reveals how men can unearth their pain, heal themselves, restore relationships, and break the legacy of abuse. He mixes penetrating analysis with compelling tales of his patients and even his own experiences with depression as the son of a violent, depressed father and the father of two young sons. Go to a video of Terry talking about men and depression

What to Do When Someone You Love is Depressed – Mitch Golant and Susan Golant

There are few circumstances in life as hard and at the same time as important as being a friend to a person who is suffering from depression. What to Do When Someone You Love Is Depressed offers guidance to the friends and family of a depressed person on how to keep one’s own spirits up and at the same time do what is best to help a loved one get through a difficult time.  Read an excerpt here

HONORABLE MENTION

 The Zen Path through Depression – Philip Martin

Extremely accessible to people with little or no Zen experience as well as to longtime students of Buddhism, The Zen Path through Depression shows how the insights and exercises of Zen offer relief for those suffering from depression.  Read an excerpt here

Beyond Blue – Therese Borchard

In this part memoir/part self-help, Therese Borchard, who blogs about depression at her site, Beyond Blue, endears herself to the reader and then reduces even the most depressed to laughter as she provides a companion on the journey to recovery and the knowledge that the reader is not alone.  Go to her popular depression blog now

Get it Done When You’re Depressed –Julie A. Fast and John Preston, M.D.

When a depressed person can’t meet the expectations of society, the depression becomes worse and a vicious cycle begins. The goal of Getting Things Done When You’re Depressed is to break this cycle. Readers will learn how to prepare themselves mentally for working while depressed, how to structure their environment so they can work more easily, how to work with others and how to prevent depression. Go to an interview with the author

The 10 Best-Ever Depression Management Techniques – Margaret Wehrenberg, Ph.D.

What I like about this book is that it provides an overview of the some of the best techniques out there that scientists and therapist are using to help and heal people from depression. As Margaret Wehrenberg explains, you must first understand your brain. Drawing on cutting-edge neuroscience research presented in a reader-friendly way, Wehrenberg skillfully describes what happens in the brain of a depression sufferer and what specific techniques can be used to alter brain activity and control its range of disabling symptoms. Containing practical, take-charge tips from a seasoned clinician, this book presents the ten most effective strategies for moving from lethargy into action, taking charge of your brain, and breaking free from depression to find hope and happiness. Read an excerpt here

 

 

Stressed and Depressed Guys in Blue Suits

Beneath the body armor of their pin-striped suits, male lawyers carry a terrible burden. Corrosive levels of stress bombard them and they’re expected to pony up and take it by fellow lawyers and judges — and themselves. There is a serious disconnect between the conversations going on inside their heads about how they really feel about their inner turmoil and the ways they present themselves to their busy world as competent, confident and glacial under pressure.

Studies show that lawyers suffer from elevated rates of stress and depression —  more than double the rates found in the general population. There are some physiological and psychological clues as to why this is so for men in the legal profession.

A new study finds that stressed men have diminished activity in brain regions responsible for understanding other’s feelings.  The study concludes that under stress, men tend to withdraw socially while women seek emotional support.  Recently, I was preparing for a trial scheduled to go on a Monday.   I had worked hard the whole weekend and was cranky and exhausted.  Sunday afternoon, my wife asked if I felt okay and whether I was stressed.  I shrugged off her question and said that I really didn’t want to talk about it. 

Yet in times when my wife is stressed, she turns to me for support and encouragement – and she’s a lawyer too.  As a man in the legal profession, I expect myself to just bear it and soldier on through the mud of litigation.  If you can’t take it, you can’t cut it goes the mindset in the legal culture.  As if there were no middle ground, no way to express this sense of free-floating anxiety.  As if it was all that simple.

There was an interesting article in yesterday’s ABA Journal, “Lawyers under Stress are Critical, Cautious and Distant, Personality Test Shows.” The tests, administered to 1800 lawyers at big firms, were conducted in collaboration with Hogan Assessment Systems, found that, on average, the lawyers:

• Generally do not seem to have a strong need for public recognition, although there is a subset of lawyers who seem to crave recognition and notoriety.

• Tend to deal with others in a direct and matter-of-fact way, but may come across as cold, critical and argumentative.

• Tend to be self-critical and temperamental but are also self-aware, open to feedback, and emotionally expressive.

• Are most attracted to environments that emphasize quality and are less commercially focused than professionals in other industries.

• Tend to value education and educational activities.

While these stress-related problems don’t necessarily cause male depression, they are additional risk factors for those are predisposed to it.

Terrence Real, author of the book “I Don’t Want to Talk about It,” makes an important point about how men deal with their melancholy: for every male who discloses his depression and gets treatment, there are four others who are able to hide it and won’t get help. He writes:

“Covert male depression has three main domains: self-medication, isolation and lashing out. Self-medication may be drinking, drugging, womanizing and even watching excessive amounts of television. Some forms of self-medication are tolerated by our culture so it is hard to get across that what these men are doing is stabilizing depression.

A covertly depressed man will isolate himself and withdraw from intimacy with his partner, his kids, his friends. He can’t afford to be intimate with others because he is desperately trying not to be intimate with himself.

Lashing out can mean violence and domestic abuse. Untreated depression may be an integral part of many male batterers.”

Men drive their pain deeper into the well of their being to avoid dealing with it, to avoid facing the fact that they feel overburdened and, perhaps, afraid.  Alone at the bottom, there is darkness with no ladder out.  Many of them will need an escape rope dropped into them by other caring people, if they are lucky to have such people in their lives.  They feel odd and alone; like they are the only man alive with this problem.

In fact, depression is a secret pain at the core of many men’s lives, and one that goes largely undiagnosed and untreated. Watch the trailer of the recent documentary “Men Get Depression” which aired on PBS:

What Men Can Do About Stress

Check out this stress blog by therapist, Elizabeth Scott.

We all know exercise is important to controlling our stress levels. The problem isn’t that we don’t know that. The problem is that we don’t do it.  Hook up with a trainer at your local gym.  It’s is a relatively cheap way to motivate you to exercise. It also makes you accountable to someone and it’s painful to the pocketbook if you blow it off – must trainers charge you for no-shows! Here’s a great blog about managing stress with exercise and a good diet from a personal trainer.  Also check out the book Spark: The Revolutionary New Science of Exercise and the Brain which has three great sections about stress, anxiety and depression and what happens to the human body when we work out. I do use a trainer and it has had a dramatic impact on stress loads I carry.

For a quick fix, check this web article “Eight Immediate Stress-Busters.”

Read an article I wrote for lawyers in December, 2008 edition of Trial Magazine, “The Connection between Stress, Anxiety and Depression.” It is a companion to Dr. Andrew Benjamn’s wise advice, “Reclaim Your Life, Reclaim Your Practice.”

What Men Can Do About Depression

Read Terrence Real’s book because it’s important for all of us to learn about depression from a male perspective.  Also check out the website Mid-Life Men which offers stories from guys about their depression experiences.

Have your wife read Is He Depressed or What? Many women ask themselves this question every day wondering whether their husband or boyfriend’s short temper, tendency to withdraw, and mysterious physical complaints might be indications of some deeper psychological issue. The book offers an overview of the ways men typically express signs of depression. It provides strategies they can use for improving communication, dealing with relationship complications, and coping with men’s physical symptoms related to depression, such as insomnia and sexual dysfunction.

Above all, the book helps your spouse avoid becoming lost in your depression. By paying attention to their own needs, they can best preserve their well-being and peace of mind—and so are able to offer the most support to you.  I often suggest that men buy this book for their wives rather than ask their wives to go out and buy it.  This demonstrates that you are in this together, that you care about her feelings and that you want her to understand.

Get help.  Therapy is not scary and you don’t have to go it alone. Therapy will help you to feel better by having someone to talk with.  Check out this article where a therapist answers seven questions about how therapy works and what to expect. It is something productive you can do about your stress, anxiety and depression and it can help you to develop some better coping skills.  If you are concerned about being seen, many therapists have early morning or late evening hours. You also tell them that you have a concern about being seen by fellow attorneys or judges and request that he or she not schedule you at a time when that therapist may be treating someone you don’t want to see.

Men, you can’t handle exorbitant levels of stress and depression on your own.  It’s not shameful to get help.

Coming Out of Our Caves: Male Depression

Guys have lots of trouble coming to terms with depression. All the more so if you’re a lawyer. Lawyers aren’t supposed to have problems; we’re supposed to fix them. Most male lawyers I know would rather drop dead than admit that they have problem with depression. I guess the exception to this observation is when the wheels have fallen off for them. Then – and only then – do they recognize (hopefully) that they are suffering from depression and the toll that it is taking on their lives. The consequences for failing to recognize this basic fact can be serious (loss of productivity at work, sleep problems, etc.) or fatal (middle aged lawyers commit suicide at twice the rate of the national average).

Psychologist, Terrance Real, the author of the book, I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, makes the observation that we don’t think of men as depressed. This is so because what we are really thinking about is “overt” depression and more women show signs of that – weeping, a willingness to discuss painful feelings, etc. Men suffer from “covert” depression that expresses itself in addiction, isolation, workaholism, isolation and increased irritability.

“Men are just as feelingful, just as relational, just as connected, just as dependent, just as needy, as women are. Men have been coerced since childhood to forego these relational qualities and skills and squeeze their sense of membership and self-esteem through performance. Girls are taught to filter their sense of self-worth through connection to others, and boys are taught to filter their sense of self-worth through performance. That’s a vulnerable foundation for one’s self-worth” notes Real in an interview.

The excellent website, Men Get Depression, says there are three distinctive signs of male depression:

Pain
Depression may show up as physical signs like constant headaches, stomach problems, or pain that doesn’t seem to be from other causes or that doesn’t respond to normal treatments.

Risk Taking
Sometimes, depressed men will start taking risks like dangerous sports, compulsive gambling, reckless driving, and casual sex.

Anger
Anger can show itself in different ways like road rage, having a short temper, being easily upset by criticism, and even violence.

So often, the first symptom that male lawyers notice that they are slipping is in the performance department. One of the symptoms of clinical depression is difficulty concentrating. This leads to problems in getting work out the door. We may try to hide that our work is slipping – ask for extensions, take much longer to do tasks that were simple and routine in the past. If the problem doesn’t go away, some will seek out help – usually through their family doctor (who distribute 80% of the prescriptions in this country for antidepressant medications). Some will go the extra step of seeing a therapist that they can talk with about their problems.

My therapist used to liken my depression to a caveman camping out in his cave. It took a lot to coax me out of there. Men need to come out of their caves into the light of day where the colors are brighter, others live who can help us and where we can finally feel the sun of being worthy without having to perform twenty-four seven in our legal careers.

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