An exploration of cultural, psychological and biological aspects of male depression.

1. MEN & DEPRESSION
Andy Novinska, LCPC, CADC
Illinois Institute for Addiction Recovery
at Advocate BroMenn

2. Disclaimer
The following presentation contains some
generalizations and stereotypes which may/may not
offend/validate what you know/may know about
men.
This information may lead you to pathologize your
sons, brothers, boyfriends, husbands, grandparents,
postman, waiter, and/or any other male figure in your
life.
Consume with care.

3. Born in the U.S.A.
Masculine Feminine
Independent Dependent
Logical Emotional
Strong Weak
Assertive Passive
Adventurous Cautious

4. Patriarchy
 American Heritage Dictionary
A social system in which the father is the head of the
family and men have authority over women and
children.
A family, community, or society based on this system or
governed by men.

5. Psychological Patriarchy
 Defining relationships between two sets of human qualities
How Can I Get Through to You? Reconnecting Men and Women, by Terrance Real
 Men and Women are both:
 Independent and Dependent
 Logical and Emotional
 Strong and Weak
 Assertive and Passive

6. Boys Learn
 Hide or disconnect from feelings/emotions
 Don’t ask for help (or admit you need help)
 Stand up for yourself (be aggressive)
 Don’t be a...
 Sissy
 Wimp
 Sally
 Punk
 Etc…
Real Boys : Rescuing Our Sons from the Myths of Boyhood by William Pollack and Mary Pipher
Be tough, big boys (real men) don’t cry

7. Emotional Life of the Male
 In general…
 Emotions live in the background of a man’s life and the
foreground of a woman’s.
 Men compartmentalize and intellectualize more.
 Men experience a harder time interpreting unspoken
messages in gestures, facial expressions and tone of voice
 Men react less intensely to emotions — and forget them
faster
The Lazy Husband by Josh Coleman, PhD
Societal norms/culture, politics, biases/prejudices, religion, temperament,
etc., all influence our emotional lives

8. Stoic Man
Stoicism
 1. indifference to pleasure and pain
 2. (Philosophy) (capital) the philosophy of the Stoics
 stoicism a form of conduct conforming to the precepts of the Stoics,
especially as characterized by indifference to pain and pleasure.
"Inside every man is a secret fear that he lacks competence and
courage, that he's not as manly as he should be. A man knows he is
supposed to take a bullet for his family. A man knows he is supposed
to fix whatever gets broken. When he's feeling powerless, when
everything he says seems to be the wrong thing, he shuts down and
withdraws. “
Mark Goulston, MD, co-author of The 6 Secrets of a Lasting Relationship

9. The Brain
Prefrontal Cortex
The impulse control center of the brain, the part of the brain
that helps us consider the consequences of our actions . This
region is not fully developed until the early to mid 20’s in
males.
Assess for:
 Drug and Alcohol
 Head trauma
 Fighting
 Sports
 Accidents
 Abuse

10. The Male Brain
 Men are hard-wired differently
 The connection between the left brain (logic) and the right
(emotion), is much greater in women.
“Women have the equivalent of an interstate highway, so they
move readily between the right and left brains. For men the
connection is like a meandering country lane, so we don’t
have such ready access to feelings.”
David Powell, PhD, president of the International Center for Health Concerns
 All things considered equal, vision trumps all senses with
men even more visual that women.

11. The Brain
Mirror Neurons
 A neuron that fires when we act out a behavior OR when
we observe a behavior in another
 Social behaviors
 Empathy
 Language
 In humans, brain activity consistent with that of mirror
neurons has been found in the premotor cortex,
supplementary motor area, primary somatosensory cortex
and the inferior parietal cortex
"The mirror-neuron system“, 2004, Annual Review of Neuroscience

12. Depression Basics
 Every year depression affects approximately
19 million Americans, or 9.5% of the U.S.
population
 Six million American men will be diagnosed with
depression this year
 At some point in their lives' 5-12% of men will
become clinically depressed
National Institute of Mental Health (NIMH)

13. Abraham Lincoln
“I am now the most miserable
man living. If what I feel were
equally distributed to the whole
human family, there would not be
one cheerful face on the earth.
Whether I shall ever be better I can
not tell; I awfully forebode I shall not.
To remain as I am is impossible; I must
die or be better, it appears to me.”

14. Adult Symptoms of Depression
 Depressed mood most of the day, nearly every day
 Markedly diminished interest or pleasure in all, or most activities, most
of the day, nearly every day
 Significant weight loss/gain or significant decrease/increase in appetite
nearly every day
 Insomnia or Hypersomnia nearly every day
 Psychomotor agitation or retardation nearly every day
 Fatigue or loss of energy nearly every day
 Feelings of worthlessness or excessive/inappropriate guilt
 Diminished ability to think or concentrate, or indecisiveness, nearly every
day
 Recurrent thoughts of death (not just fear of dying), recurrent suicidal
ideation without a specific plan, or a suicide attempt or a specific plan
for committing suicide

15. Feminizing Depression
“If modern psychologists were shown to understand
how men's emotions affect their behaviors, it's
only because their predecessors long ago
decided that having a uterus was the main risk
factor for mental illness. During the last two
centuries, depression was largely viewed as a
female problem, an outgrowth of hormonal
fluctuations stemming from puberty, childbirth
and menopause”
Julie Scelfo, Newsweek, Feb. 26, 2007

16. Feminizing Depression
“We tend not to recognize depression
in men because the disorder itself is
seen as unmanly. Depression carries,
to many, a double stain-the stigma of
mental illness and also the sigma of
feminine emotionality”
Terrence Real

17. “Male” Symptoms of Depression
 Frustration & Irritability
 Anger & Aggression
 Risky Behaviors (reckless driving, acting out sexually, gambling, etc.)
 Alcohol or Substance abuse
 Physical Ailments (pain, digestive issues, headaches)
 Overworking (“workaholic”)
 Excessive Television (sports)
 Excessive Gaming or Internet Use
“As I reflect on over 30 years of clinical experience, I am appalled at the
realization that I have misdiagnosed male depression many times”
Dr. Archibald Hart Psychologist and Author of Unmasking Male Depression

18. What's at Stake?
“Children of depressed parents have high rates of depression and
anxiety disorders that are impairing and reoccur over the course of
their lives"
Myrna Weissman, Ph.D.
 Children with depressed parents have three times the rate of anxiety
disorders, major depression, and substance use disorders
 Adult children whose parents were depressed have about five times the
rate of cardiovascular illness as children of non-depressed parents
 Twice as many kids of depressed parents (19 percent) developed an
addiction to drugs or alcohol, as did those of non-depressed parents (8
percent)
Offspring of Depressed Parents: 20 Years Later, 2006
Men & Depression: Facing Darkness, Newsweek, 02/2007

19. Men & Suicide
 Although women
attempt suicide more
often than men, men
are four times as likely
to complete suicide
 Men take an average
of just 12 months to go
from contemplating
suicide to attempting
suicide.
National Institute of Mental Health
(NIMH)

20. Cause of Death?
 Suicide
 Covert Suicide (staged accidents)
 Accidents (due to high risk behaviors)
 Neglect of overall health
 Violence/Homicide
 Strokes
 Heart Attack
 ____________________

21. Heart Disease and Depression
 People with heart disease are more prone to develop
depression
 People with depression are more likely to have heart
disease than otherwise healthy people
National Institute of Mental Health (NIMH)
 Men with depression and heart disease are two to three
times more likely to die than men with heart disease who
are not depressed (3)
Men and Depression: New Treatments, Newsweek 02/2007

22. Working with Men
 Assess for other disorders such as:
 Anxiety, PTSD, sexual impulsivity, gambling issues
 Be careful of jumping to axis II
 Explore family history
 Use a concrete tool such as the LEQ
 Discuss male role models
 Including athletes and media figures
 Teach the language of emotions
 Work with the left brain!

23. Working with Men
 Talk “side-by-side”
 Physically getting in a man’s face makes may trigger confrontation
(watch personal space)
 Coping skills
 Exercise! Release stress and manages anger (cortisol goes down,
dopamine and endorphins go up)
 Diet
 Hobbies/Interests
 Painting, playing a musical instrument, woodworking, etc.) can tap into a
man’s emotions
 Explore parenting and partnering skills
 Look for mentors (even surrogate ones!)

24. Thank You
Andy Novinska, LCPC, CADC
Illinois Institute for Addiction Recovery
at Advocate BroMenn
Andrew.Novinska@advocatehealth.com