Psychology
18 Sep 2018

A man with depression? Impossible

Pessimism, low self-esteem, feelings of guilt and other symptoms of depression can clash with the traditional image of a man and make him fear for his masculinity. 

Wysokie Obcasy
Magdalena Karst-Adamczyk Wysokie Obcasy, Global
A man with depression? Impossible - NewsMavens
Sad man, PixaBay

--The following fragments are from Magdalena Karst-Adamczyk’s interview with Professor Piotr Gałecki, a national consultant in psychology, which appeared in the Polish weekly “Wysokie Obcasy” in October 2017.

Magdalena Karst-Adamczyk: Who is more prone to depression, men or women?

Piotr Gałecki: Women. But they’re also the ones more likely to seek professional help. Men rarely decide to see a specialist and many of those who do visit a therapist don’t stick to the treatment plan; they skip doses of prescribed medications, stop taking them too early, or above all, mix them with alcohol.

MKA: Do men and women experience depression differently? 

The basic symptoms and the course of illness are very similar. The only significant difference is that men suffering from depression become more aggressive and irritable; previously trivial problems or situations suddenly start to annoy them. 

The most common causes of depression or suicide in men also differ from women’s. Men often develop a depressive disorder after becoming unemployed or losing a substantial amount of money, due to their lack of ability to achieve a certain social status, after a serious accident that left them physically impaired or after a partner’s betrayal. Women don’t usually try to kill themselves because they’ve lost their job.

We need to stress that society is still more inclined to recognize depression among females than among males. What is more, depressed women are often given more support and understanding than men suffering from the same condition.

A man with depression? No one even considers such possibility.

We don’t accept male depression because we associate it with weakness. Pessimism, low self-esteem, feelings of guilt and other symptoms clash with the traditional stereotype of man as a strong and brave hunter, and deprive him of his masculinity. A woman bursting into tears at work can count on her colleagues’ sympathy or — worst case scenario -- their indifference. But shedding a tear in the workplace could ruin a man’s career. This is why men suffer in silence. Usually they don’t want to admit to their illness or, once they have admitted it, they refuse to see a professional because they treat psychotherapy as another sign of weakness.

MKA: As opposed to women, men don’t share their problems. Conversation is useful, but is it really that beneficial for people with chronic depression? Does it change anything?

Suppressed, unspoken issues have a dangerous tendency to build up. Women find talking about their troubles almost natural and by doing that, they reduce their weight. They’re also more likely than men to admit to mistakes and ask for help -- it’s one of their strengths.

Apart from many other advantages, conversation also provides us with information. By talking about depression, people get a chance to learn about its causes, symptoms and available methods of treatment. They can realize that this kind of illness could be the result of psychological crisis or life difficulties, but it might also be the consequence of diseases such as hypothyroidism, rheumatoid arthritis or type 2 diabetes. People look at depression in the same way they used to look at cancer. It scared them so much, they preferred to avoid check-ups. The rate of deaths from cancer is dropping not because the disease itself has become less common, but because -- due to people’s growing awareness -- it’s detected and treated at earlier stages.

Hopefully, one day we’ll become as cautious and sensible about depression as we are about cancer.

MKA: Conversations with others teach us that antidepressants are not as scary or dangerous as we often presume. People are afraid that due to pharmacological treatments, they won’t be able to drive a car or that their libido will drop or completely disappear.

These medications are safer than antibiotics and more effective! They don’t change a patient’s personality or cause cognitive disorders. Swallowing too many antidepressants won’t kill you either.

MKA: When does pharmacotherapy become necessary?

Depression can be mild, moderate or severe, depending on the severity of symptoms. If we’re talking about the mild type and the first depressive episode -- psychotherapy should be a sufficient method of treatment. If it’s a second or further episode -- our patient most likely requires medications. 60-70% of patients achieve full remission of symptoms after 3 months of pharmacological treatment but the therapy should be continued over the next 6 months and then a further 2 years to prevent the relapse or recurrence of the episode.

MKA: In which stage of depression people decide to undertake therapy?

During the first depressive episode a patient’s condition is usually more severe than in consecutive episodes, because they have failed to recognize the illness. If the depression relapses, a patient is already familiar with the symptoms and consequences and tends to react more quickly. 

MKA: When do people require inpatient treatment?

When they start showing suicidal tendencies.

Thoughts about death appear sooner or later. First, as a “death wish” -- a patient wouldn’t dare taking their own life, but also wouldn’t object to dying of natural causes. Then they move on to contemplating and considering suicide and, eventually, start planning their own death.

It’s the last call; their final chance to return to a normal life, and impossible to achieve without hospitalization. This form of therapy is also necessary in case of treatment-resistant patients or those suffering from delusions which can often lead to psychotic depression.

MKA: I have two sons. It’s impossible to protect them from all the difficulties they may have to encounter in the future. But is there anything I could do to reduce the risk of depression or to instill in them the idea that mental illness is not a shameful matter, neither for men or for women?

First of all, you should never describe the world as an evil and hostile place. It could result in avoidant or paranoid personality disorder. People suffering from these two conditions treat every situation as a potential source of danger and stay constantly alert, like a prey ready to flee from its predator. Secondly, you need to prepare them for failures: try not to wrap them in cotton wool and let them face their difficulties.

Without failure, there’s no success. The sooner men realize that, the better. 

MKA: Preparing my sons for failure still sounds like raising them to be stereotypical hunters. Yet I don’t want them to feel pressured. Nobody’s perfect -- I’d like them to know that it’s ok to feel weak and fragile. How about teaching them to talk about their emotions?

I admit that it’s important, but talking about our feelings is one thing and being able to recognize them, is another. Only 7-8% of the information we send is expressed verbally. Everything else is hidden in the tone of our voice, our body posture and gestures. While women are skilled people readers, men often struggle to comprehend these encrypted signals and consequently, they notice problems with a certain delay. If you manage to teach your sons to not only talk about their emotions but also to identify them, they might have a chance to avoid many unnecessary conflicts in the future.

***

--If you or a someone you know needs psychological support, please visit this European Union page for a database of helplines available in your country.

Translated from Polish by Martyna Kardach

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