The Sad Truth About Men

In the middle of the journey of our lives,

I found myself upon a dark path. --Dante

When Terrence Real was a boy, his father routinely threatened to beat him within an inch of his life. And on any number of occasions, that is apparently pretty much what he did.

But it didn’t occur to the boy that his father might have been suffering too until he was 27 and, as a therapist-in-training, found himself sitting with his father, prepared at last to understand.

Now the son is himself middle-aged. The violent, artistic father is dead, and Real is reaching into his own past to describe the “dark, jagged emptiness” that has plagued men for generations.

Until now, there has been no formal clinical description for the numbing desperation that drives many men into what were once dismissed as midlife crises. But in his first book, “I Don’t Want to Talk About It” (Scribner), Real not only talks about it, he gives it a name: covert depression.

“This is one of the most prevalent disorders in modern American society and yet it is almost completely ignored,” Real says. “There is nothing less than a cultural cover-up about depression in men. And it has been going on for centuries.”

As far back as Aristotle, who reasoned that the coldness of life could be warmed by the heat of drink, poets and other writers have often penned the feelings they cannot articulate any other way. Henry David Thoreau was certainly in tune with the feelings of many of his gender, then and now, when he observed, “The mass of men lead lives of quiet desperation.”

Almost a century later, T.S. Eliot described another generation of numb men--men isolated even from themselves, men who needed understanding: “Remember us--if at all--not as lost / Violent souls, but only / As the hollow men / The stuffed men.”

Real’s book is the most provocative in a flood of new books on depression. While “I Don’t Want to Talk About It” is the only volume that speaks exclusively to and about depressed men, there seems to be a growing interest in talking about the increasing incidence of depression among men--its patterns, cruelty, even its contagion.

From a study of how the symptoms of depression spread through families like a head cold in winter to the discovery that depression generally is a not a onetime event but a cyclical disorder that can appear and reappear throughout one’s life, the new focus on depression as an illness that probably hits men at least as hard as it hits women is well-timed for American baby boomers turning 50.

For years, such gurus of the men’s movement as Robert Bly, John Bradshaw and the late Joseph Campbell warned men of the high price they pay for withholding their feelings. Whether the depression is expressed as a sleeping disorder, irritability, indecisiveness, a sense of worthlessness or recurrent thoughts of death, experts say the condition can be especially difficult to diagnose in men.

In his book, “The Good News About Depression” (Bantam), bio-psychiatrist Mark S. Gold relates this example as typical of an exchange with a male patient:

“ ‘Are you in pain?’ I ask the patient.

“ ‘Not particularly,’ he answers and he means it because he has lived with pain for so long that for him it no longer seems unusual.”

Studies at Stanford University of coping styles in men and women suggest that men are far less likely to handle depression by ruminating. That is, they focus less on their symptoms and tend not to try to understand or analyze them, says Dr. Susan K. Nolen-Hoeksema.

*

Finding little research directed solely at understanding and quantifying depression in men, Real sampled a few Bly men’s groups in gathering information for “I Don’t Want to Talk About It.” Bly has long supported the theory that men “inherit depression” from their fathers and, like Real and other therapists, believes that the rising incidence of domestic violence may reflect a similar increase in undiagnosed depression among men.

By allowing men to be more open--and with such consciousness-raising rituals as drumming and hugging--Bly’s “mythopoetic men’s movement” has forged a trail for many men, Real suggests. “While I’m not one of these guys who goes off in the woods for weeks at a time, I see clearly that there is a place for that sort of safe expression.”

Claude Saks, 59, doesn’t know if he was clinically depressed or not when he set out to change his life 20 years ago. It is clear that despite his great worldly success as the head of the country’s major coffee importer, Saks was miserable in a way he could not define.

Saks was forced into his father’s coffee import business at an early age. He had other plans for his life but his father would hear none of them. So Saks learned the ropes, assumed his father’s cutthroat style, left the company and returned as his father’s single most relentless competitor.

“I wanted to bury him,” writes Saks in his autobiographical adventure book, “Strong Brew: One Man’s Prelude to Change” (Heartsfire Books). And bury his father he did.

But besting his father in business just years before his death wasn’t what changed his life. It was the heart attack Saks suffered at 39 and, weeks later, the jolt of learning that his teenage son had been hit by a car. The son survived and, just as remarkably perhaps, so did Saks.

“For me, that heart attack and nearly losing my son was the wake-up call I could not ignore,” says Saks, who now teaches Taoist meditation and leads men’s groups in New Mexico. The alarm he sounds in his book is an invitation to introspection--the self search that experts say most men need to begin before they can climb out of their spoken or unspoken despair.

*

Current research confirms that a vulnerability to depression is most probably an inherited biological condition. With the right mix of chromosomes, any man--or woman--is susceptible. It is also well-known that people with heart disease are more likely to be depressed than others.

Whether it was a biochemical tendency toward atherosclerosis or a genetic predisposition to the type A lifestyle, Saks, like many highly successful men, sees his heart attack as the price he paid for losing touch with the joys of his family relationships.

Real calls this the “chain of pain”--a toxic legacy linking parent to child across the generations. “Because of what our culture continues to do to little girls and little boys, men and women handle their feelings very differently. Everything men do and feel gets filtered through performance--their achievements. Women’s self-esteem tends to be more relationship-oriented.”

And that difference can ultimately pay off for women. Recent research at the University of Houston has confirmed that marriage, for example, can protect many men from depression. The assumption is that close, reliable relationships are needed more by men than by women, who are more comfortable expressing pain and asking for help.

For decades, students of human behavior have recognized that depression in men is often masked by other antisocial behaviors--drinking, drugs, domestic abuse, workaholism. The sadness stays hidden.

In William Styron’s powerful book about his own depression, “The Darkness Within” (Random House, 1990), the novelist describes alcohol as the central factor in his depression--the “mood bath” that kept his demons at arm’s length. Going on the wagon, Styron says, “allowed the depression to crowd in.”

*

Unlike women and girls, who tend to internalize their pain and blame themselves for what’s wrong with their lives, men and boys are more likely to feel victimized by others, some psychologists say.

“This is one major reason depressed men may strike out at their wives, their children, their co-workers,” Real says. “And if they can’t, they’ll find addictions to soothe the pain, self-medicating with sex, gambling, booze, whatever.”

Even when therapists get past such “masking behaviors,” Real says, the therapist himself may be reluctant to suggest the diagnosis of depression.

“Depression in men,” Real proposes, “is in itself seen as unmanly and shameful. That can make it difficult for a therapist or physician to pronounce the diagnosis, to slap a patient with such an insult.”

Yet, once it is diagnosed, depression is the most treatable of all behavioral disorders. Thanks to a host of new therapies and cures, says bio-psychiatrist Gold, “You couldn’t have picked a better time in human history to feel miserable.” With a combination of psychotherapy and new psychiatric drugs, between 80% and 90% of depressed patients get relief.

Without treatment, it can be deadly. Statistics show that men kill themselves at least four times as often as women do.

For too many, that is the first--and last--symptom of their depression.