Question. I am attempting to research the area of male depression. Through my experience of working with clients and my current reading it, would seem clear that men do not express their depression along the lines of the symptoms presented in the DSM-IV. It appears to be particularly “feminine” symptomology or a societal expectation of feminine expression. I wish to explore how men tend to act out their emotions or hide their emotion through actions such as violence, substance abuse or workaholism. I would appreciate your comments and perhaps some comment on where to find more information.
Answer. I am not sure I entirely agree with the premise of your question, though I do think you are on to something. In my experience as a psychiatrist, most severely depressed men, like most severely depressed women, satisfy most of the typical DSM-IV criteria for major depression. There are exceptions, of course, so-called “atypical” depression with its anxious, phobic, somatizing features; hypochondriacal forms of depression; depressive states expressed as chronic pain, etc. But in the main, I have always found the DSM criteria a very useful starting point for diagnosing depression in men or women.
There is some evidence that women experience more depressive symptoms for a longer period of time than do men. But at least one large study found men and women with major depression (Research Diagnostic Criteria) to have quite similar symptom profiles, on the whole.
That said, I do think that men may show some differences in the way they express depression, perhaps reflecting the divergent cultural influences on men and women in Western society. (I can’t rule out inherent biological differences, either). I think men more often fit Peter Sifneos’ description of alexithymia than do women; i.e., the men are often woefully unable to recognize or at least verbalize their feelings. At times, this seems to be part of the macho culture of the “strong, silent type” epitomized by John Wayne. So, as I’m sure you’ve found, when you ask some men if they are depressed, they may shrug their shoulders and say, “No way, Doc! I just wanna kill myself.”
Even the Frank et al study found some differences between men and women; e.g., women reported more appetite and weight increase, more somatization, and showed greater levels of expressed anger than men. The women also took longer to respond to treatment. Re: alcoholism and sociopathy, there is a school of thought that views these conditions as “the man’s way of expressing depression”. However, I don’t think there is compelling empirical evidence for this; e.g., most studies of alcoholism and depression have found that these are independent disorders. For more details on this interesting issue, you may want to see the chapter by Wolk & Weissman in the American Psychiatric Press Review of Psychiatry, volume 14, 1995. Good luck with your research!
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