Depression in Men: Understanding the Missing Piece

Avoiding help and being a man have become synonymous. From professional athletes to sitcom portrayals of dads, we are told that a man’s gotta do what a man’s gotta do and he often has to do it alone.   

A main reason why men avoid seeking help is due to gender role socialization, the beliefs and expectations that we have for how a man should think and behave. Men should value certain ideals, such as being in control, being financial providers, and restricting emotions. When men allow themselves to experience emotions, it should be only anger or rage. These emotions propel the man to action versus emotions like sadness, shame, or loneliness, which heighten vulnerability and undermine the power and control he has been taught to seek.

When men restrict emotions, they also restrict expressions of emotions, such as crying. Boys who are raised to believe that crying is weakness eventually grow up to be men who are skilled at hiding their true feelings.

This phenomenon becomes meaningful in the assessment and treatment of men with depression. Many therapists are trained to see emotions, such as sad mood, as the hallmark symptom of depression. But how do we accurately assess and treat depression if a man avoids emotions? Instead of the stereotypical sad mood, men may exhibit masculine-specific depressive symptoms such as anger, conflict with family or spouse, increased substance use, or workaholism.

At face value, these symptoms are not assumed to be related to depression. The image of an angry person and a depressed person are quite different. However, men may feel safety expressing anger more than sadness, or may use substances to blunt the impact of depression. I have seen many men in therapy who believed that their problem was mismanaged anger, drinking a little too much, or not knowing how to communicate with their spouse. When we examined these symptoms through the lens of depression, therapy became more meaningful. These men were able to acknowledge the long-lasting impact of depression and gained insight to change.

Many men do not realize that there is a hidden link between masculinity and depression. Men need to receive therapy that acknowledges gender influences and examines how they influence psychological wellness. My specialization in men’s issues led me to become a psychologist in the U.S. Navy and contributor to the academic journal, Psychology of Men & Masculinity. Learn more about my approach to therapy here or schedule an initial phone consultation here.

Contributions from Rabinowitz & Cochran (2008).

Therapy with Men is Different (and why this matters)

Therapy with men is different. Choosing a therapist who understands these differences matters.

My interest in men’s issues began while working at a community mental health agency. I was the only male therapist on staff which meant any male client who requested a male was automatically matched with me. I became curious about some recurring themes I heard in the therapy room. My training at this agency eventually concluded, but my interest in men’s issues persisted.

I joined the U.S. Navy as an active duty psychologist to continue to provide mental health services to men. My experiences in the Navy have shown me that there are common beliefs men have regarding seeking therapy.

“I should be able to do it on my own.”

Most men arrive to a therapist’s waiting room with ambivalence. They have been instructed to be ruggedly individualistic since childhood, and when this fails, they are at a loss as to how to solicit help. The therapeutic process is fundamentally about collaboration and recognition rather than individualism. Journeying with men while they understand their psychological needs for relationships can be a highly curative factor.

“Behavior should be valued over feelings.”

Most men are socialized to believe that feelings are unproductive. They may rhetorically ask, “Why feel sad? Sadness over a loss will not undo the loss.” In these instances, therapy can be helpful to understand flexible emotional expression. While feeling sadness is not going to undo a loss, feeling sad may help unresolved grief.

“I don’t have a problem feeling emotions. I get angry all the time.”

Anger is an emotion that some men are not afraid to feel because it propels them toward action. Inaction is often avoided by men as it can be associated with weakness, indecisiveness, or other traits stereotypically opposed to what they believe a man should be. Therapy illuminates how other emotional processes can also promote action, such as approach instead of avoidance after experiencing shame.

 “I’ve tried therapy before but I ended before I felt better.”

Men have historically lower rates of mental health seeking behavior than their female counterparts. They may also end therapy prematurely when compared to women. This unfortunate reality may be reduced if men are informed about the process of therapy from the beginning. Reminding men that participating in therapy may elicit conflict with earlier messages they’ve received about masculinity (e.g.., that it’s difficult to relinquish control and vulnerability is not weakness) can help to improve success in therapy.

If you've recognized some of these statements, schedule a free phone consultation here or learn more about my approach and credentials here.