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

by Terrence Real

Hidden depression drives several of the problems we think of as typically male: physical illness, alcohol and drug abuse, domestic violence, failures in intimacy, self-sabotage in careers.

Girls, and later women, tend to internalize pain. They blame themselves and draw distress into themselves. Boys, and later men, tend to externalize pain; they are more likely to feel victimized by others and to discharge distress through action.

Depression in men, unless it is dealt with, tends to be passed along. That was the case with my father and me. And that was the situation facing David Ingles and his family when we first met.

This attitude often compounds a depressed man’s condition, so that he gets depressed about being depressed, ashamed about feeling ashamed. Because of the stigma attached to depression, men often allow their pain to burrow deeper and further from view.

Over the last twenty years, researchers have investigated the relationship between traditional masculinity and physical illness, alcohol abuse, and risk-taking behaviors—and have demonstrated what most of us already know from common experience: many men would rather place themselves at risk than acknowledge distress, either physical or emotional.

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.

“Masked depression is one of the most prevalent disorders in modern American society, yet it is perhaps the most neglected category in psychiatric literature.” That neglect continues. If overt depression in men tends to be overlooked, covert depression has been rendered all but invisible.

The curse of Narcissus is immobilization, not out of love for himself, but out of dependency upon his image.

Developmental theorists call this crucial component of healthy parenting “unconditional positive regard.” The parent’s warm regard, the “gleam in the mother’s eye,” is internalized by the young child and becomes the seed of his own capacity for self-regard.

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 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.

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

The covertly depressed man, in contrast, relies on such external stimulants to rectify an inner baseline of shame. Nondepressed men turn to mood-altering behaviors like drinking, gambling, or sex for relaxation, intimate sharing, or fun. Covertly depressed men turn to such substances or activities to gain relief from distress.

Other addictive choices, like workaholism for men or obsessive weight reduction for women, are less obvious because they are not only tolerated by our culture but often actively rewarded. Even the language of addiction in such instances can seem overblown and easy to dismiss. But the persistence of any behavior in the face of known harmful consequences qualifies as an addiction. Just because a supplement for self-esteem is socially rewarded does not mean that it will not have disastrous consequences for the individual who relies on it.

In theory an addictive relationship can be established with just about anything, so long as the substance, person, or activity relieves the threat of overt depression. To accomplish this, the defense must transform one’s state from shame to grandiosity, from feelings of worth-less-ness to feelings of extraordinary worth and well-being. In common language, this sudden shift in consciousness is called intoxication. Along with the obvious effect of drugs or alcohol, one can also get “high” from the rush of physical violence, the applause of an audience, a sexual conquest, a killing in the stock market.

The only real cure for covert depression is overt depression. Not until the man has stopped running, as David did for a moment that day in my office, or Thomas did when he let himself cry, can he grapple with the pain that has driven his behavior. This is why the “fix” of the compulsive defense never quite works. First, the covertly depressed man must walk through the fire from which he has run. He must allow the pain to surface. Then, he may resolve his hidden depression by learning about self-care and healthy esteem.

The relaxation of self-boundaries lies at the core of intoxication with drugs like alcohol, morphine, and heroin. Various forms of bingeing—eating, spending, sex—can provide this same sense of expansion.

Only after the shame cycle has stopped, after the addictive pattern itself has been broken, and after the person has moved into “sobriety” can the pain of covert depression be addressed.

Less fortunate are those covertly depressed men who turn for self-medication not to substances but to people, as in a love addiction, or to actions, particularly violence.

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

Freud once wrote: “The first man to hurl an epithet instead of a stick was the creator of civilization.”

For most boys, the achievement of masculine identity is not an acquisition so much as a disavowal. When researchers asked girls and women to define what it means to be feminine, the girls answered with positive language: to be compassionate, to be connected, to care about others. Boys and men, on the other hand, when asked to describe masculinity, predominantly responded with double negatives.

boys’ acquisition of gender is a negative achievement. Their developing sense of their own masculinity is not, as in most other forms of identity development, a steady movement toward something valued so much as a repulsion from something devalued. Masculine identity development turns out to be not a process of development at all but rather a process of elimination, a successive unfolding of loss. Along with whatever genetic proclivities one might inherit, it is this loss that lays the foundation for depression later in men’s lives.

First, why must we distinguish between the gender development of boys and girls to begin with? As anthropologist Barrie Thorne points out, a woman’s basic femininity is never questioned in our culture. There may be questions raised about what kind of woman she is—flirtatious, tough, even “butch”—but it is rarely in doubt that she remains a woman,

Boys do not need to be turned into males. They are males. Boys do not need to develop their masculinity. They are masculine, no less than girls are feminine.

The idea that boys must rupture an effeminizing connection to mother is one of the oldest, least questioned, and most deeply rooted myths of patriarchy.

As devastating as the disconnection from the mother may be, it is merely the beachhead of a larger social mandate, the instruction to turn away, not just from the mother, but from intimacy itself, and from cultivating, or even grasping, the values and skills that sustain deep emotional connection.

a covertly depressed man is one who finds the vulnerability of depression unacceptable even to himself.

think of depression as an auto-aggressive disease, a disorder in which the self turns against the self.

This perspective enables us to metaphorically draw a line down the center of a piece of paper creating two columns. On one side, we list the “feminine,” the lost boy, overt depression, shame, and victimization. On the other, we list the “masculine,” the harsh boy, covert depression, grandiosity, and offense.

Through the mechanism of carried shame and carried feelings, the unresolved pain of previous generations operates in families like an emotional debt. We either face it or we leverage our children with it. When a man stands up to depression, the site of his battle may be inside his own head, but the struggle he wages has repercussions far beyond him.

Self-esteem, for example, is not something one has; it is something one does.

Pia Mellody has devised a five-point grid that I find practical and comprehensive. It consists of five self functions: self-esteem, self-protection, self-knowledge, self-care, and self-moderation.

Men agreed—for their and their family’s well-being—to abdicate many of their deepest emotional needs in order to devote themselves to competition at work. Women agreed to abdicate many of their deepest achievement needs in order to devote themselves to the care of everything else, including their working husbands. I call this deal the core collusion. It is at this juncture that the roles of man-the-breadwinner and woman-the-caretaker were born. A women accomplished her new, critical role as the husband’s ministering angel by seeing not just to his physical needs, but to his psychological needs as well. As

If the relationship of most traditional wives to their breadwinning men is one of caretaking, of “building up the male ego,” then the wife’s relationship to a depressed spouse represents a kind of caretaking doubled. Wives of depressed men tend to blame themselves; they try to cajole their husbands into getting help. They may nag; they may complain. But until things get truly dismal, they seldom put their foot down,

In trade for his own emotional betrayal, Joe received the payoff of grandiosity. Like many narcissistically wounded, successful men in our culture, Joe took a profound conviction of his own superiority out into the world, and the world rewarded him for it. But then Joe’s luck faltered. He had made a grand showing until the day the whole thing came tumbling down around him. Since his sense of worth was synonymous with the success of the business, when it crashed, Joe’s self-esteem bankrupted right along with it.

For generations, traditional men have been willing to slog their way through combat trenches, dirty, mean jobs, dangerous occupations, to sacrifice their health, even lie down and die, for the sake of their breadwinner roles. Men have enjoyed the “privilege,” as more and more angry voices are rising to say, of killing themselves. In return, what men have been promised is an appreciative, saintly wife—a whore in the bedroom, a kitten on the living room couch, a scintillating cocktail companion, and a damn fine cook and homemaker. This is not a mature relationship. It is what I have taken to speak of with couples as traditional emotional pornography.

The archetype of the sexual mother embodies a dream of being limitlessly given to; being perfectly nurtured, as a child is nurtured by a mother; being regarded as a perfect lover, perfect husband, someone’s Prince Charming. This vision precludes a few nasty realities, like the negotiation of another’s needs, doing things wrong and having to learn how to do them differently, struggling with moments of profound loneliness.

Men like Joe Hannigan have been raised with the delusion that “their women” take active pleasure in demanding nothing from them. This is emotional pornography—the idea that a good woman is one who is happy to take care of—and leave alone—her breadwinning man.

Women, traditionally barred from direct confrontation, have learned the “feminine wiles” of management. Women’s protectiveness is inherently condescending, a sisterly solidarity that says, “We know better. We must look after these children we have married.” For all their vaunted superiority, a great many men intuit that their wives are managing them. Women, in this culture, have been taught to be indirect, manipulative, and silent, while men have been taught to ignore their women, punish them, or feel wounded by them if they dare speak out. Neither Narcissus nor Echo is well equipped by traditional socialization to take his or her place at the negotiation table. Barbara Hannigan vacillates between being silent about her needs and screaming them out in a rage when she finally blows up. Her work is to learn assertion without aggression. Joe needs to wake up to the responsibility of listening, of bringing himself to the negotiation table to begin with.

There is some indication, for example, that human males are, if anything, more emotional than human females. Male babies have been shown consistently to exhibit greater separation distress when they are left by their mothers, to be more excitable, more easily disturbed, and harder to comfort.

Both forms of depression in men, overt and covert, frequently evoke in mates an urge to protect their husbands. If overtly depressed men often implicitly demand care, covertly depressed men often implicitly demand dysfunctionality. The spouse of a covertly depressed man may offer herself up as a scapegoat, expressing his projected vulnerabilities for him. This is a phenomenon called adult-to-adult carried feelings.

did, I do believe that any man who has struggled in his life with a deep, core experience of depression will need help not only in learning how to cherish himself, but also in learning the art of cherishing others.

What the ethic of man-the-breadwinner has ignored is the wisdom of relationship. That wisdom—shared by most human cultures throughout the globe—has as a central tenet that it is a source of one’s own growth to care for the context one lives within. It is essentially an ecological wisdom, teaching that we are not objective observers standing above and acting upon a passive world. We do not stand apart from a system, like God, but within it—whether the system is our body, our psyche, our marriage, our state, or our planet. Tending to the well-being of contexts we live within is an exercise of mature self-care, self-interested sacrifice.