I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression

by Terrence Real

drowning person will grip you,” my father told me, “if you get in too close. They’ll pull you down with them. You should throw them something, a rope, a life preserver. But don’t touch them, don’t go in after them.”

Most of my father’s gestures, his expressions, were broad, coarse, larger than life, like his body, like the clay figures he sculpted in our garage—abstract, looming shapes with massive limbs—or like his rage, which came as suddenly as a storm, with no particular intent or thought, like some dark animal, some bear.

warmth, an infectious laugh. After she died, things went downhill for my father’s father, Abe, “a weak, passive man.” Abe lost his job, bought a little mom-and-pop store; then he lost the store. Unable to support itself, the family broke up.

As Thoreau once wrote: “The mass of men lead lives of quiet desperation.” Others, not so quiet. When we think of depression, it is to those “others, not so quiet” that our thoughts usually turn.

the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM IV) which labels a person as having a clinical depression only if he or she shows, for a duration of at least two weeks, signs either of feeling sad, “down,” and “blue,” or having a decreased interest in pleasurable activities, including sex. In addition, the person must exhibit at least four of any of the following symptoms: weight loss or gain, too little or too much sleep, fatigue, feelings of worthlessness or guilt, difficulty making decisions or forgetfulness, and preoccupation with death or suicide. The condition described in the DSM IV is the classic form of depression most of us think of.

“black bile,” which in Greek reads melanae chole, or melancholia.

Our current patterns of judgment and denial about depression are reminiscent of the older moralistic attitudes toward the disease of alcoholism, and the source of our minimization is much the same now as it was then. The issue is shame.

As a society, we have more respect for the walking wounded—those who deny their difficulties—than we have for those who “let” their conditions “get to them.”

man brought down in life is bad enough. But a man brought down by his own unmanageable feel-ings—for many, that is unseemly.

In The Things They Carried, Tim O’Brien gives a clear example of the force of men’s shame, when he remembers his fellow “grunts” in Vietnam: They carried their reputations. They carried the soldier’s greatest fear, which was the fear of blushing. Men killed, and died, because they were embarrassed not to. It was what brought them to the war in the first place, nothing positive, no dreams of glory or honor, just to avoid the blush of dishonor. They crawled into tunnels and walked point and advanced under fire. They were too frightened to be cowards.

Men’s willingness to downplay weakness and pain is so great that it has been named as a factor in their shorter life span. The ten years of difference in longevity between men and women turns out to have little to do with genes. Men die early because they do not take care of themselves. Men wait longer to acknowledge that they are sick, take longer to get help, and once they get treatment do not comply with it as well as women do.

And our love of invulnerability shows little sign of abating. Both celebrities and ordinary men across the country have developed a new fascination with muscle. Every one of 256 nonmuscular adolescent boys studied by psychologist Barry Glassner demonstrated either mood or behavioral disruptions related to feelings of inadequacy.

great many men never make it into the official roll call of the depressed because their overt depression remains undiagnosed. But other men, like David, fail to get help because their expression of the disease does not fit the classic model as described in the DSM IV. David suffers from what I call covert depression.

My work with families like the Ingleses has convinced me that many of the difficult behaviors one sees in men’s relationships are depression driven.

While psychiatry has put little effort into exploring the nature of covert depression, art, poetry and drama have all drawn rich material from this human condition.

“Narcissus was loved by many,” the poet Ovid introduces his tale. “Both youths and young girls wanted him; but he had much cold pride within his tender body: no youth, no girl could ever touch his heart.”

People often think of Narcissus as the symbol of excessive self-regard, but in fact, he exemplifies the opposite.

Narcissus did not suffer from an overabundance of self-love, but rather from its deficiency. The myth is a parable about paralysis.

As Ficino remarked, if Narcissus had possessed real self-love, he would have been able to leave his fascination. The curse of Narcissus is immobilization, not out of love for himself, but out of dependency upon his image.

covert depression is at its core a disorder of self-esteem.

Healthy self-esteem presupposes that all men and women are created equal; that one’s inherent worth can be neither greater nor lesser than another’s.

But our basic sense of self as valuable and important neither rises nor falls based on external attributes.

Society bids many of us to forget about inherent worth and, instead, to supplement the deficiency with external props such as wealth, beauty, status. The greater the scarcity in true self-esteem, the greater the need for supplementation.

Narcissus, “full of cold pride,” presents an appearance of untouchability. But the myth understands his secret vulnerability. Lacking the capacity for an authentic relationship, he becomes enthralled and eventually enslaved by his own reflection.

Narcissus in love with his image is like a man in love with his bank account, his good looks, or his power. Narcissus is an emblem for all men enthralled with just about anything other than their own deepest selves.

lifetime of inattention to his emotions and his relationships was perched precariously over a childhood of profound psychological neglect. While Thomas kept a clear focus on his “life goals,” the future he wanted, he had utterly disregarded his history. He had turned his back on the past he no longer wished to be a part of. The problem with his strategy of disowning pain was that his feelings did not cooperate very well. David Ingles turned his back on the depressed, vulnerable boy inside himself, only to wind up replaying the scene of his injury with his own son.

Whether he knew it or not, Thomas was running. Running toward the goal of financial security, to be sure, but also running from the pain and emptiness he had felt as a child, escaping the sense of unworthiness and emotional impoverishment that had haunted him throughout much of his life.

Like most covertly depressed men, Thomas had trouble bearing real intimacy with others because he could not afford to be emotionally intimate with himself.

For David and Thomas, the pain they had but refused to feel stemmed from a toxic relationship to the self, what psychiatry labels a self disorder.

self attacks the self.

The patient represents his ego to us as worthless, incapable of any achievement and morally despicable; he reproaches himself, vilifies himself and expects to be cast out and punished. He abases himself before everyone and commiserates with his own relatives for being connected with anyone so unworthy. He is not of the opinion that a change has taken place, but extends his self-criticism back over the past; he declares that he was never any better. This picture of a delusion of (mainly moral) inferiority is completed by sleeplessness and refusal to take nourishment, and—what is psychologically very remarkable—by an overcoming of the instinct which compels every living thing to cling to life.

In psychiatry today, the self-attack Freud describes would be called shame, an acutely uncomfortable feeling of being worth-less, less than others.

state of numbness, which is known in psychiatry as alexithymia. This experience of depression is not about feeling bad so much as about losing the capacity to feel at all. They are like the souls in the lowest rung of Dante’s Inferno, who were not seared in fire but frozen in ice.

In overt depression, the anguish of shame, of the toxic relationship to the self, is endured. In covert depression, the man desperately defends against such an onslaught. A common defense against the painful experience of deflated value is inflated value; and a common compensation for shame, of feeling less than, is a subtle or flagrant flight into grandiosity, of feeling better than.

Five suicide attempts in two years followed this realization, all of them serious, workmanlike. Brad was tranquilized, hospitalized, even given electroshock therapy. Then one day, he finally let go of his dreams of adulation, his version of Narcissus’s sprite.

From a frightened little brother, he built himself up to become a physically imposing man. He sought out fame and adoration and settled for the illusion of tenderness in sex.

Remember us,—if at all—not as lost Violent souls, but only As the hollow men The stuffed men. —T.S. ELIOT

But while the capacity to externalize pain protects some men from feeling depressed, it does not stop them from being depressed; it just helps them to disconnect further from their own experience.

Men do not have readily at hand the same level of insight into their emotional lives as women, because our culture works hard to dislocate them from those aspects of themselves. Men are less used to voicing emotional issues, because we teach them that it is unmanly to do so.

Overt depression, prevalent in women, can be viewed as internalized oppression, as the psychological experience of victimization. Covert depression, prevalent in men, can be viewed as internalized disconnection—the experience of victimization warded off through grandiosity, perhaps through victimizing.

And yet, for reasons that I have never seen explained, as a profession we have decided that when the boy hits the magic age of eighteen he is no longer depressed; he has crossed the Rubicon into the land of the personality disordered. This is not reason. This is moral judgment. This is the psychiatric equivalent of transferring a kid from “juvie” court to go stand for his crimes “like a real man.”

But it is clear that the stable ratio of women in therapy and men in prison has something to teach us about the ways in which each sex is taught by our culture to handle pain.

The common denominator linking them all is violence. All of these men are violent toward themselves, as Styron was to the point of near suicide, or violent toward others, as David was to Chad and Damien was to Diane. And the origins of so much violence can be traced to the ordinary, everyday violence our boys are immersed in as a central part of their socialization.

Like a lot of men, Michael, while appearing independent, had staved off his covert depression with his relationship. Along with the trauma of his wife’s news and his grief for his marriage, Michael was in the acute phase of withdrawal from love addiction.

it, I was in no hurry to take the crisis away. Working with covertly depressed men has taught me to respect crisis as a potential ally.

Michael was blissfully unaware of the impact he had on others.

“The mass of men lead lives of quiet desperation.” Others, not so quiet.

Since Freud’s first formulation of depression as a kind of mourning, most psychological theories about the disorder have focused on the role of early childhood injury and loss.

British child analyst John Bolby detailed case after case of childhood vulnerabilities resulting from even relatively minor disruptions in parental contact.

Childhood injury in boys creates both the wounds and the defenses against the wounds that are the foundation for adult depression.