YOU might call it melancholy on steroids -- a muscular mixture of fast-driving, heavy drinking, hard-charging cussedness. For perhaps 3 million American men yearly, that's the plotline for depression.
For almost 24,000 men yearly, the final scene is suicide. Often, there is no cry for help, no river of tears, no abyss of sadness. Just a violent, tragic bolt from the blue.
In the United States, a man is four times more likely than a woman to commit suicide, according to government statistics. Yet, he is only half as likely to be diagnosed with depression. That stark disconnect underscores a simple fact about depression in men: It often does not look like the mixture of sadness, guilt and withdrawal that dominates diagnostic descriptions and popular perception of the disease. As a result, a man's depression is often missed -- by loved ones, by physicians, by the sufferer himself.
The costs are steep: in lives hobbled, jobs lost, relationships ruined. Some professionals even tally the toll in prison terms, substance-abuse statistics and shattered communities.
For The Record
Los Angeles Times Thursday October 20, 2005 Home Edition Main News Part A Page 2 National Desk 1 inches; 38 words Type of Material: Correction
Male depression -- A photo caption in Monday's Health section with an article about depression and men said John Head was the author of "Lay My Burden Down." In fact, the book's author is Dr. Alvin F. Poussaint.
For The Record
Los Angeles Times Monday October 24, 2005 Home Edition Health Part F Page 8 Features Desk 1 inches; 38 words Type of Material: Correction
Depression -- A photo caption with an article about depression and men in last week's Health Section said John Head was the author of "Lay My Burden Down." In fact, the book's author is Dr. Alvin F. Poussaint.
But today the diagnosis of depression is in the midst of a long-overdue makeover, as medical and mental health professionals have come to recognize that in at least half of depressed men, the recognizable litany of symptoms don't really fit.
'Their way of weeping'
Some depressed men may be plagued by impotence and loss of sexual interest, but others may become wildly promiscuous. Many complain of depression's physical symptoms -- sleep troubles, fatigue, headaches or stomach distress -- without ever discerning their psychological source. Compared to women suffering depression, depressed men are more likely to behave recklessly, drink heavily or take drugs, drive fast or seek out confrontation.
Instead of acting like they are filled with self-doubt, depressed men may bully and bluster and accuse those around them of failing them. For many men, anger -- a masculine emotion that one "manages" rather than succumbs to -- is a mask for deep mental anguish.
"That's their way of weeping," says psychologist William Pollack, director of the Centers for Men and Young Men at McLean Hospital in suburban Boston and an expert on depression in men.
Dr. Thomas Insel, director of the National Institute of Mental Health, likens the shift now taking place among psychologists and psychiatrists to one that is taking hold in other areas of medicine. In the diagnosis of, say, heart disease, physicians have come to recognize that men and women can have the same illness, but their symptoms often look very different.
In any given year, says Insel, 6.4 million men will be diagnosed with depression -- and many health professionals think that number may be far too low. Insel's institute has launched a broad campaign to raise awareness of the depression that affects men.
Steve Klepper is one of those men. For almost two decades as an aerospace machinist in San Diego, a coffee-fueled Klepper worked so much overtime that he was able to buy a family home by himself. At work, he says, he was short-tempered and had little patience for his co-workers' blather about friends and family.
At home, he would drink himself numb virtually every night. By his own admission, he "acted very much like a jerk" to women and friends, and suffered constant stomach problems and skin rashes. He thought frequently of suicide.
Today, Klepper manages his condition with medication, and leads a San Diego support group for those suffering depression and bipolar disorder. He finds it hard to fathom why no one ever called his evident depression what it was. But he knows why it's a hard diagnosis for a man to admit to himself.
"It's embarrassing to be sad," he says. "And the difference between being sad and lazy is hard to distinguish."
Neither tears nor indolence, it seems, are manly virtues.
"Depression equals vulnerability and shame and lack of functioning. That takes away the man's masculinity -- and for men, that takes away the sense of self," says Pollack, author of "Real Boys: Rescuing Our Sons from the Myths of Boyhood." In the American ethos, Pollack says, "a man who's vulnerable is not even a man any more.... It's the equivalent of being psychologically castrated."
Pollack and a small but growing number of depression experts say it's time for the mental health profession to expand its definition of depression so it is better recognized in men. They are pushing for a new category of depression -- Pollack calls it "male-based depression" -- to be incorporated into the new "Diagnostic and Statistical Manual," the bible of the mental health profession that is being updated.
The reformers could easily cite Bill Maruyama as male-based depression's Exhibit A.
As a Japanese-American kid growing up in Inglewood after the Watts riots, Maruyama outwardly nurtured a demeanor that was all "swagger and bravado" but in reality it was a veneer hiding the torment of rising depression.
Alone, in secret, he often cried.