She has trouble getting out of bed, perhaps confides in a few close friends, and is likely to seek professional help. He gets irritable and nasty, bottles up his feelings inside, and the last thing he wants to do is talk to a counsellor. Both are depressed, but, at least in its early stages, female and male depression look very different.
Male depression is also far more likely to be deadly, as recent headlines sadly demonstrate: German billionaire Adolf Merckle killed himself by lying down in front of a train near his home, despondent over money problems.
Former South Korean President Roo Myo-hun hurled himself off a cliff near his home, tortured by allegations of corruption. Gay Men's Health Crisis founder and author Rodger Mc-Farlane was found dead, leaving a suicide note citing debilitating back and heart problems.
A new study from researchers at the University of Montreal gives some insight into why so many men try to "tough out" their depression. Aline Drapeau and colleagues remind us that, in Canada at least, "women are more likely than men to use mental health services when they face light or moderate mental health problems."
They note that one impediment to men seeking help is the strong stigma that men attach to professional care of any kind. However, our roles in society may also be a factor. Women are responsible for caring for a sick child or spouse more often than men. When they take time off from work, co-workers tend to understand, and forgive the imposition.
On the other hand, one study found that "male workers who took some time off were rated as less performing than those who did not." In his aptly-titled book I Don't Want to Talk About It -- Overcoming the Secret Legacy of Male Depression (Scribner, $17.50) Harvard psychotherapist Terrence Real calls chronic depression a "silent epidemic in men." He notes the "problems that we think of as typically male --difficulty with intimacy, workaholism, alcoholism, abusive behaviour, and rage -- are really attempts to escape depression."
Real explains that "women tend to internalize pain, while "boys, and later men, tend to externalize pain: they are more likely to feel victimized by others and to discharge distress through action." Hence the statistics, which show that women attempt suicide more often than men, yet males actually kill themselves at a rate three to four times higher than females.
Analyzing this phenomenon, Dr. George E. Murphy of Washington University writes in Comprehensive Psychiatry that "women process their experiences with friends," and "are much more likely to tell a physician how they feel and co-operate in the prescribed treatment. As a result, women get better treatment for their depression."
So how can we help men and boys out of the pit of depression? One of the best analysts of the male psyche, in my opinion, is William Pollack, author of Real Boys and several other perceptive guidebooks. His main premise is that "males are shame-o-phobic." Doesn't that ring true every time you see a guy do something dumb just to avoid being shamed in front of his friends?
Admitting to being depressed is the ultimate shame for many men because, as Real notes, "depression carries, to many, a double stain --the stigma of mental illness and also the stigma of 'feminine' emotionality."There is a third path, but it's not really open for individuals to choose. As a society, we can admit the reality, and the normality, of male depression, and try to detoxify the feelings around it.