Quiet Desperation: The Male Manifestation of Depression

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“There is a blackness that has lain inside the center of my being…this jagged, empty, frightened feeling has been a part of my internal atmosphere for as long as I can remember. It has been my baseline, my steady state—the me that I have been running from…”

This is a description of feelings from a man with depression, taken from a very profound book I recently finished entitled “I Don’t Want to Talk About It” by Terrence Real. Within the book, Real takes a long, hard look at male depression and sheds light on how depression manifests itself differently in males than females. He calls it a “terrible collusion in our society, a cultural cover-up about depression in men”.

The book not only discusses depression, but the societal idealized male in relation to the condition. As I read, I recognized many men in my life within his description of depression. However, most of all, I recognized the experience of the firefighter.

In many ways, firefighters are the epitome of the masculine ideal in society. They are the strong, brave, rescuers among us who we can always count on in any situation. We cling to this image so strongly that we often forget they are people with feelings, who face horrific situations every day that can affect them emotionally.

This book addressed how our societal ideals of men in general are helping to mask a plague of “covert” depression among them.

Overt vs. Covert Depression

Depression symptoms and treatment have been studied primarily from a female perspective, and women definitely manifest depression differently than men. Women blame themselves, tend to talk about their feelings more and show visible signs of their despair. In contrast, men tend to blame others and find it “weak” to talk about their feelings. They may also self-medicate with alcohol, exercise, sex and the endless process of goal attainment, to name a few.

When we think of depression, we think of depression as acute and dramatic episodes that make it impossible for the individual to function or lead them to suicidal thoughts. Real calls this debilitating condition, “overt depression” and the kind of depression we envision when we hear the word. It is dangerous, but he asserts there is another kind of depression that is not even being addressed in society. He calls it “covert depression”, a state of depression in a man that is hidden from the man’s own conscious awareness, yet drives many of his actions. In fact, for the man suffering with covert depression, the answer to the problem is action itself. If he keeps busy, he can disconnect from his feelings and won’t have to deal with them. Action is his salvation.

This again, reminded me so much of firefighters because firefighters are above all, men of action. Many men, firefighters included, are raised that way. The societal male ideal is a strong, stoic man who enjoys sports, can fix things, can solve problems and above all, doesn’t feel. Even a man raised as a sensitive artist is aware that society expects him to be a certain way, as a man, and he may choose to deal with his feelings as society dictates. A “real man” doesn’t sit around and wallow in his problems. A “real man” does something about it.

This is why many men keep their depression under wraps, or “covert”. Real describes covert depression as elusive and chronic. It is the result of the way we consciously or unconsciously treat our men to deal with their emotions. Unconsciously, we raise our men to be tough little soldiers who keep their emotions to themselves. The male ideal is to be impenetrable to pain, and never show vulnerability. Society teaches men that pain is something to rise above. A man whoshares his emotional pain may even be shamed and therefore begin to feel he is “less than” because of his feelings. He may be told to “stop being a baby”, “man up” or worse, in the case of someone with a stressful job like firefighting, that they “just can’t handle the job”.

Girls, in contrast, are allowed to express themselves emotionally and even encouraged to seek out emotional connections for support and talk about their feelings when needed. Men are encouraged to be assertive, to achieve and to handle anything that comes their way by themselves. They are encouraged to disconnect, not to feel, so they can perpetuate society’s expectation of the bulletproof male. The problem with this is that by doing so, men often fail to develop the skills they need to express emotion and appreciate deep connection. They keep their pain to themselves.

So, while a woman with depression may receive significant support from friends and family, a man with depression may not even be recognized. The symptoms even mask the condition because male depression leads to problems we can misunderstand as “typically male” activities: physical illness, alcohol and drug abuse, domestic violence, failures in intimacy, affairs, addiction to pornography and increasingly risky behaviors. Often these men are paralyzed by a feeling of “numbness”, which is a term I have heard firefighters use to describe their feelings. Often, men who exhibit these undesirable behaviors just want to feel something. They seek a “drug” or stimulant of some kind, whether it’s a substance, sex or gambling, to continue to mask their feelings of depression.

In contrast, a male with covert depression may exhibit “positive” symptoms that reinforce the male ideal, like goal achievement at work, workaholism, exercising obsessively, pursuing athletic achievement, etc. Society rewards high achievers and healthy athletes, so society, in essence, praises the man for hiding his depression; it is masculinity at its finest. Yet Real warns that these “positive” behaviors can be none the less damaging to the man, his marriage and his family. The children of the workaholic feel neglected, or the wife may leave, all as a result of a covert man not acknowledging his feelings. Of course all positive actions are not signs of covert depression or addiction. To learn more about the difference, see the sidebar article, “Is it Addiction?”).

Both the negative and positive activities of covertly depressed men help them perform the ultimate defense and “cover-up” desired by society: to run from their feelings.

Running from Depression

Society teaches women to verbalize feelings and externalize pain. Men are taught to discharge distress with action, which is something firefighters do every day. To rise above the pain or stand up to the discomfort of his feelings, a man needs to stay in action. A man in action doesn’t have to face his feelings or dealwith the pain of them. If a man cannot rise above the pain, he gets “depressed about being depressed, ashamed about being ashamed”. Real says the sad truth is that “many men would rather put themselves at risk than acknowledge physical or emotional distress”. This may explain the rise in suicide among firefighters in recent years and the statistic that men are four times as likely to take their lives than females. In the case of the firefighter with covert depression, this may even creep into the job, with the firefighter taking increasing risks as their depression deepens.

For the man with covert depression, the greatest fear is in the loss of the action. If they stop achieving, taking risks, drinking or whatever their distraction is, they will have to deal with their feelings. They fear that if they stop acting they will be acted upon. Their feelings will engulf them and they will become incapacitated. In other words, they fear the onset of the overt depression. They believe as long as they keep “running”, they can stay ahead of that overt depression. If they stop, they may be doomed.

This is a real, not imagined, concern for the depressed. He instinctively knows he is inches from an overt depression because he is. Women, because they are more aware of feelings, are better at heading off depression and asking for and receiving support than men are. They rally support and take the time to grieve. For men, it’s easier to keep running.

Firefighters Facing Depression

Real asserts that when it comes to depression in men, “biological vulnerability contributes to depression, but this alone is not enough to bring about the disorder. It is the collision of inherited vulnerability with psychological injury that produces depression”. Exploring this psychological injury requires moving a man from the safe, socially accepted, confines of covert depression to the vulnerable, socially isolating, unpredictablestate of overt depression. The injury may be from psychological trauma or neglect; something from the deep past or something recent. Whatever it is, it must be acknowledged and discussed for the healing to begin.

Talking about the feelings, the events, etc. with peers, friends, family members or therapists is the first step. Art Zern, who is Assistant Fire Chief in Sycamore and is part of the Illinois Firefighter Peer Support Team, said he believes many suffer in silence because of the fire departments culture of service, so the job has a very high hidden cost and no one gets out unscathed.

Also, firefighters are always firefighters, even when they are off duty. They carry a heavy burden of responsibility to “save the world”. Art gave the example of the off duty firefighter who witnesses an accident or horrific event right before his eyes that he is unable to do anything about, simply because he is not on duty and does not have his equipment and gear on at the time.

“While the average civilian that witnesses an event is surely traumatized, the first responder also feels guilt, responsibility and shame for being unable to “save the day” as is expected of him from the public and himself. We can deal with losing a fair fight but it’s very hard to deal when the deck is stacked against you,” Art said. “When I started this job 35 years ago, talking about the events of our job and the endless trauma was not even a consideration. All of the damage was hidden and our culture had been a major contributing factor in firefighter suicide and behavioral health issues. Sadly, we have done it to ourselves to a great degree.”

Retired Fire Captain Chuck Wehrli is a program coordinator of the Illinois Firefighter Peer Support team. He also acknowledges that the recent spotlight on firefighter behavioral health is long overdue. “We have done a bad job over the years helping our own until the last decade,” he said, “and peer support has been one of the best avenues in getting help. We need to talk to others that have been through the same situations and realize we aren’t that rock all the time; we need support also.” He also said it is important for fellow department members to constantly be on the alert for depression in others and ourselves. A firefighter is subject to many things that can lead to depression: bad calls, pressures from family and spouses, interdepartmental strife. He said we owe it to our co-workers and ourselves to address behavioral health problems sooner.

Society may have made it more difficult for men to acknowledge their depression but at least today firefighters have a safe place to go where their feelings won’t be judged. If you feel that you may be exhibiting the signs of covert depression, I urge you to receive the help and support you deserve. Whatever the problem, talking about it with open honesty can ironically be considered the truest form of “manning up”.

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