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Drowning
Drowning
Etienne Dubuis

GENEVA - Depression is usually associated, in our minds, with women. Yet of course men suffer from it too, and often it comes with an extra stigma even in our modern society.

Genevan psychiatrist Theodore Hovaguimian talks about it in his new book, La Depression Masculine (Male Depression). This breakthrough book helps break a taboo that can sometimes have dramatic consequences.

Depression is fundamentally a reaction to an important loss: the loss of a loved one, the loss of a status or the foreseen loss of life itself. This creates a special reaction: feelings overflow and destroy instead of rebuilding. What is considered as an irreparable loss? Here is the first difference between men and women, says Dr. Hovaguimian. The trigger for women is usually linked to their love life, the absence of motherhood or children leaving the nest – while for men the trigger is linked to work, a layoff or retirement.

No matter what the reasons are, men are affected by depression as much as women. But they are not depressed as often as women – this is the second important difference between the two genders. This difference is part of the reason why male depression is often overlooked. The gap varies depending on age, but in general, men are half as likely to be depressed than women.

The difference is quantitative but also qualitative. Men suffering from depression usually show very different attitudes than women suffering from the same condition. Men have also much more difficulty accepting their situation and are prone to denial. Less inclined to question themselves, they find a thousand reasons to blame others for what they are feeling, and can become very irritable. They have frequent explosions of anger, which contrast highly with the general feeling of sadness depression is known to bring on. Furthermore, instead of sinking into apathy, they often become hyperactive, giving the image of being strong, when inside they are really feeling very weak.

“Men see their body like a machine,” explains Dr. Hovaguimian. “When it doesn’t work, they punch it hard. Unlike women, they are less likely to analyze and question themselves. This kind of attitude has its advantages. Rushing headfirst into action can help protect and comfort oneself. Nevertheless this attitude has also its disadvantages.”

More explosive, the masculine personality can lead to escapism and alcohol – and sometimes even violence. “Men tend to withdraw into themselves and get less involved in their family or professional life in order to invest themselves in a superficial social life, such as the one that be found in bars,” observes Dr. Nathalie Nanzer, from the Child and Teenager Psychiatric Services of the Geneva University Hospitals.

Waiting for help

Theodore Hovaguimian says it is a kind of a Stockholm Syndrome, in reference to the syndrome where hostages end up bonding with their kidnappers. “When they have been hostage by depression, women call for help, while men tend to withdraw into themselves in a face-to-face with depression, which consists in surrendering to their persecutor.”

“Men are more reluctant to see a specialist,” confirms Alain Sauteraud, a psychiatrist in Bordeaux, “and when they finally do, it’s at a more advanced state of depression. Before going to see a doctor, they will have already resorted to products like nicotine, alcohol or cannabis.”

This kind of behavior complicates the detection of depression. As much as women attract sympathy by sharing their problems, men become unlikeable by closing themselves off to others and being aggressive. Hence it is not surprising that female depression can be detected and treated much earlier than male depression.

“In this kind of situation, seeing a family doctor is the best thing,” says Dr. Nanzer. “A practitioner who knows his patient well will be able to tell if his patient has always been angry or if he suddenly became like this – and be more likely to diagnose the presence of depression.”

Another obstacle to the detection of male depression is to blame on society. We learn early on that “Boys don’t cry.” So how could they be depressed? “Doctors themselves, men or women, have a tendency not to look for depression in men,” says Dr. Hovaguimian, who explains doctors often look for organic reasons for male depression, instead of psychological reasons.

By continuously denying the truth, and living in a society that refuses his weakness, a man who is experiencing depression will be all the more easily rejected by society than a woman. This can lead to homelessness and suicide. “Men get depressed half as much as women but commit suicide twice as much,” says Dr. Hovaguimian.

He says that there is an efficient way to talk to depressed men: by telling them the truth – that depression is nothing to be ashamed of but a sickness. By telling them that they are not powerless victims and that their recovery depends on them. They should also be told that they should not feel guilty about what is happening to them but that they should take charge. It’s ok to fight as long as you are fighting against an enemy that has been identified.”

“If we want to improve the way we treat male depression, progress has to be made,” says Dr. Sauteraud. We have to improve society’s acceptance of it. The best thing we can do is to raise awareness about it. Don’t forget that some of the world’s most famous historical figures suffered from depression.”

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