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Thu, 05/22/2008 - 9:49am
Breaking the Silence
By Michelle Apuzzio
Sometimes it's numbness; other times it's a crying jag. Sometimes it's uncontrollable rage; other times it's re-reading the same page without absorbing it. Depression has many symptoms that slowly erode the lives of its prey, destroying everything in its wake - marriages, families, careers. Help is out there, for sure. But many men won't ask for it.
Steve has battled bipolar disorder, formerly known as manic depression, nearly his whole life. The formal diagnosis was at age 20 in 1969, but the Watertown father of two remembers feeling guilty, worthless and stupid occasionally as a child. Later the manic episodes caused spending binges; the depression elicited suicide plans. He didn't have the concentration to write his dissertation even though he'd finished courses for a PhD. He floundered from job to job with no real purpose. There were good times, but sometimes that made him feel worse. If he had a job interview on a 'good day,' he felt that he was misrepresenting himself, which made him guilty and ashamed. And suicidal.
"The sense of shame and self-loathing is more lethal than the illness itself," said Steve, 58.
That shame is rooted in our environment, Steve believes. It's the environment that says men cannot have depression, leading them to suffer in silence.
Michael Addis, PhD, began the Men's Coping Project at Clark University to study why
men are less likely, compared to women, to seek help for depression. The two-year study consists of face-to-face interviews and a computer survey that ask questions about men's perspectives of themselves, beliefs about depression and seeking help and their understanding of the different treatment options available.
For many men who may have depression, they view this drudgery as their "lot in life," and are hopeless that things could be different, noted Addis, professor and chair of Clark's psychology department. He believes those men's views towards getting help stem from how they are raised - men are often taught to ignore their feelings and tough it out. Addis hopes to "break the culture of silence surrounding men's mental health." He and his colleagues have interviewed about 70 men, some of whom have sought help after their consultations.
The Stress of Parenthood
While we don't know what causes depression the stress of fatherhood can bring on an episode. Steve was able to adapt after his first son was born, but he strongly advocated against having more children despite his wife's (now ex-wife) desire to have another.
When his second son was born, Steve's life started unraveling. He remembers being so depressed at times he could do nothing more than put on a video and sit with his youngest son. He wanted the boy to feel that dad was physically present, even though he couldn't interact with him. Other times Steve might overreact to a simple question, like "Will you play ball with me, Dad?" Frequent depression meant Steve was often absent from family gatherings and vacations.
Dan Fields, 43, a father of two from Framingham, was also depressed after the birth of his first child. Fields has had dysthymia, a low-grade depression, since adolescence. As a teen, he wondered if it was just the usual teen angst, especially when he was relatively symptom-free in his 20s. But depression crept back into his life when he became a father, manifesting as extreme irritability and hypersensitivity to noise in the house. He was defensive to perceived criticism and usually on-edge.
Pinpointing the Issue
Psychologists use a standard set of symptoms to diagnose depression, including lack of interest or pleasure, weight and sleep changes, fatigue, sense of worthlessness or guilt, inability to concentrate and recurrent thoughts of suicide. But William Pollack, PhD, director of the Centers for Men and Young Men at McLean Hospital, who also teaches psychology at Harvard Medical School, said that depression in men often starts with irritability or angry outbursts and theorizes that this may be the one emotion that society allows men to show. Men may also engage in risk-taking and bravado behavior, such as getting into fights.
Taking that first step towards a diagnosis is usually the hardest. Julie Totten, founder and president of Waltham-based Families for Depression Awareness, said that the most downloaded article on the organization's Web site is "When Depressed Husbands Refuse Help." Totten founded Families for Depression Awareness in 2001 after her brother committed suicide in 1990, and she helped her father get treatment for his depression afterwards. The organization advises families on coping with depression. First you have to determine if the person might have the disease. Totten's brother had "all the classic signs," she said. He had lost a lot of weight and was very withdrawn. They had gone to a movie together, and he didn't laugh at all. She never asked if he was contemplating suicide because she didn't want to "put the thought into his head." She now advises people to ask. Getting a family member into the doctor can be a challenge. When her father suspected he might have the flu, Totten called his physician before the appointment to ask for a depression screening.
Fortunately Steve and Fields all got the help they needed, but a common factor was their desire to avoid medication until it was absolutely necessary. "If I took the medication it would be a daily reminder that something inside of me was broken and needed to be fixed," Steve said.
Today all three men are on regular medication, and Addis and Pollack say that treatment is much more sophisticated than even a decade ago. Pollack added that many men begin with one of the many variations of talk therapy and gradually add medication. Fields credits the treatment with saving his marriage.
"There was more than once that I didn't think our marriage would survive my emotional ups and downs," he said. He advises other men to be patient while they are responding to medication because it can take several weeks to find the right dosage.
While dad is in treatment, the degree of family involvement will vary by case, noted Pollack. Yet it is important to educate everyone. Kids will learn why dad is acting a certain way and understand that it's not his or their fault. Since depression tends to run in families they'll also know how to deal with it in the future.
In addition to seeking the help they needed for themselves, Aronson and Steve are reaching out to schools, colleges and businesses to share the facts about depression in men. Talking about it will slowly remove the stigma of the disease, they hope.
What to do when the person won't seek help
"Try an indirect approach," Trotten suggests. Say something along the lines of "I care about what's bothering you." They may associate their feelings with a physical problem. Call the doctor in advance to ask for a depression screening and offer to accompany the person. You can ask friends or relatives who have had depression to talk with your loved one or you can ask if they'll seek help out of concern for their children.
How to tell if it's really depression
The key is to look at the big picture. If there's a reason for your grumpiness, it's probably an isolated incident. Dr. Pollack advises people to seek help if they are shifting towards bad patterns. Are you becoming increasingly irritable and withdrawn? Is it hard to interact with your family? Do you feel like you're not yourself lately?
National Institutes of Mental Health "Real Men, Real Depression" http://www.nimh.nih.gov/health/publications/men-and-depression/summary.shtml
Men's Coping Project at Clark University
www.menandcoping.net
Manic Depressive and Depressive Association of Boston
www.mddaboston.org
Families for Depression Awareness
www.familyaware.org
Michelle Apuzzio is a freelance writer in Dedham. Contact her at apuzzio@verizon.net.
Breaking the Silence
Depression is a real issue of men, especially dads
By Michelle ApuzzioSometimes it's numbness; other times it's a crying jag. Sometimes it's uncontrollable rage; other times it's re-reading the same page without absorbing it. Depression has many symptoms that slowly erode the lives of its prey, destroying everything in its wake - marriages, families, careers. Help is out there, for sure. But many men won't ask for it.
Steve has battled bipolar disorder, formerly known as manic depression, nearly his whole life. The formal diagnosis was at age 20 in 1969, but the Watertown father of two remembers feeling guilty, worthless and stupid occasionally as a child. Later the manic episodes caused spending binges; the depression elicited suicide plans. He didn't have the concentration to write his dissertation even though he'd finished courses for a PhD. He floundered from job to job with no real purpose. There were good times, but sometimes that made him feel worse. If he had a job interview on a 'good day,' he felt that he was misrepresenting himself, which made him guilty and ashamed. And suicidal.
"The sense of shame and self-loathing is more lethal than the illness itself," said Steve, 58.
That shame is rooted in our environment, Steve believes. It's the environment that says men cannot have depression, leading them to suffer in silence.
Michael Addis, PhD, began the Men's Coping Project at Clark University to study why
men are less likely, compared to women, to seek help for depression. The two-year study consists of face-to-face interviews and a computer survey that ask questions about men's perspectives of themselves, beliefs about depression and seeking help and their understanding of the different treatment options available. For many men who may have depression, they view this drudgery as their "lot in life," and are hopeless that things could be different, noted Addis, professor and chair of Clark's psychology department. He believes those men's views towards getting help stem from how they are raised - men are often taught to ignore their feelings and tough it out. Addis hopes to "break the culture of silence surrounding men's mental health." He and his colleagues have interviewed about 70 men, some of whom have sought help after their consultations.
The Stress of Parenthood
While we don't know what causes depression the stress of fatherhood can bring on an episode. Steve was able to adapt after his first son was born, but he strongly advocated against having more children despite his wife's (now ex-wife) desire to have another.
When his second son was born, Steve's life started unraveling. He remembers being so depressed at times he could do nothing more than put on a video and sit with his youngest son. He wanted the boy to feel that dad was physically present, even though he couldn't interact with him. Other times Steve might overreact to a simple question, like "Will you play ball with me, Dad?" Frequent depression meant Steve was often absent from family gatherings and vacations.
Dan Fields, 43, a father of two from Framingham, was also depressed after the birth of his first child. Fields has had dysthymia, a low-grade depression, since adolescence. As a teen, he wondered if it was just the usual teen angst, especially when he was relatively symptom-free in his 20s. But depression crept back into his life when he became a father, manifesting as extreme irritability and hypersensitivity to noise in the house. He was defensive to perceived criticism and usually on-edge.
Pinpointing the Issue
Psychologists use a standard set of symptoms to diagnose depression, including lack of interest or pleasure, weight and sleep changes, fatigue, sense of worthlessness or guilt, inability to concentrate and recurrent thoughts of suicide. But William Pollack, PhD, director of the Centers for Men and Young Men at McLean Hospital, who also teaches psychology at Harvard Medical School, said that depression in men often starts with irritability or angry outbursts and theorizes that this may be the one emotion that society allows men to show. Men may also engage in risk-taking and bravado behavior, such as getting into fights.
Taking that first step towards a diagnosis is usually the hardest. Julie Totten, founder and president of Waltham-based Families for Depression Awareness, said that the most downloaded article on the organization's Web site is "When Depressed Husbands Refuse Help." Totten founded Families for Depression Awareness in 2001 after her brother committed suicide in 1990, and she helped her father get treatment for his depression afterwards. The organization advises families on coping with depression. First you have to determine if the person might have the disease. Totten's brother had "all the classic signs," she said. He had lost a lot of weight and was very withdrawn. They had gone to a movie together, and he didn't laugh at all. She never asked if he was contemplating suicide because she didn't want to "put the thought into his head." She now advises people to ask. Getting a family member into the doctor can be a challenge. When her father suspected he might have the flu, Totten called his physician before the appointment to ask for a depression screening.
Fortunately Steve and Fields all got the help they needed, but a common factor was their desire to avoid medication until it was absolutely necessary. "If I took the medication it would be a daily reminder that something inside of me was broken and needed to be fixed," Steve said.
Today all three men are on regular medication, and Addis and Pollack say that treatment is much more sophisticated than even a decade ago. Pollack added that many men begin with one of the many variations of talk therapy and gradually add medication. Fields credits the treatment with saving his marriage.
"There was more than once that I didn't think our marriage would survive my emotional ups and downs," he said. He advises other men to be patient while they are responding to medication because it can take several weeks to find the right dosage.
While dad is in treatment, the degree of family involvement will vary by case, noted Pollack. Yet it is important to educate everyone. Kids will learn why dad is acting a certain way and understand that it's not his or their fault. Since depression tends to run in families they'll also know how to deal with it in the future.
In addition to seeking the help they needed for themselves, Aronson and Steve are reaching out to schools, colleges and businesses to share the facts about depression in men. Talking about it will slowly remove the stigma of the disease, they hope.
What to do when the person won't seek help
"Try an indirect approach," Trotten suggests. Say something along the lines of "I care about what's bothering you." They may associate their feelings with a physical problem. Call the doctor in advance to ask for a depression screening and offer to accompany the person. You can ask friends or relatives who have had depression to talk with your loved one or you can ask if they'll seek help out of concern for their children.
How to tell if it's really depression
The key is to look at the big picture. If there's a reason for your grumpiness, it's probably an isolated incident. Dr. Pollack advises people to seek help if they are shifting towards bad patterns. Are you becoming increasingly irritable and withdrawn? Is it hard to interact with your family? Do you feel like you're not yourself lately?
National Institutes of Mental Health "Real Men, Real Depression" http://www.nimh.nih.gov/health/publications/men-and-depression/summary.shtml
Men's Coping Project at Clark University
www.menandcoping.net
Manic Depressive and Depressive Association of Boston
www.mddaboston.org
Families for Depression Awareness
www.familyaware.org
Michelle Apuzzio is a freelance writer in Dedham. Contact her at apuzzio@verizon.net.
