Women seek help. Men die.
Ernst and Angst (1992)
This stark conclusion was drawn following a study of suicide prevention by Ernst and Angst (1992). They found that 75% of those who sought professional help in an institution for suicide prevention were female. Conversely, 75% of those who committed suicide in the same year were male. Since depression is a significant risk factor for suicide and men receive less treatment for depression than women, it is vitally important that we have a better understanding of the way depression manifests itself in males. Failure to diagnose and treat depression can lead to significantly increased morbidity and mortality. Considering that depression is the most frequent reason for suicide, early diagnosis of depression in men can save lives.
Morris is a 42-year-old Caucasian male, seen in the hospital following a suicide attempt in which he took an overdose of sleeping pills. In the initial interview he didn’t appear to be sad or depressed; rather, he seemed frustrated, irritable, and angry. Morris reported that he had had difficulty finding a job in his chosen profession as a writer and he blamed “the corporate control of publishing companies” for not giving him a chance to demonstrate his talents. He maintained that he wasn’t depressed and that, while he had taken too many sleeping pills, he wasn’t really trying to kill himself. His wife was distraught.
“I never suspected he might be depressed,” she said. “He was just withdrawn and irritable all the time. I always had to walk on eggshells. I never knew when he was going to blow up. I tried to be supportive of his writing career, even when it was difficult to make ends meet. We have a five-year-old son. I haven’t told him why his father is in the hospital. I guess, I don’t really understand it myself.”
Morris refused any kind of counseling, but a better picture emerged when his wife found a journal he had been keeping. At first she thought he was describing a character in a story. Then she realized he was talking about himself.
June 4: Your flesh crawls, your scalp wrinkles when you look around and see good writers, established writers, writers with credits a block long, unable to sell, unable to find work. Yes, it’s enough to make anyone turn pale and sicken.
August 15: Faster, faster, faster, I walk. I plug away looking for work, anything to support my family. I try, try, try, try, try. I always try and never stop.
November 8: A hundred failures, an endless number of failures, until now, my confidence, my hope, my belief in myself, has completely run out. Middle aged, I stand and gaze ahead, numb, confused, and desperately worried. All around me I see the young in spirit, the young in heart, with ten times my confidence, twice my youth, ten times my fervor, twice my education.
I see them all, a whole army of them, battering at the same doors I’m battering, trying in the same field I’m trying. Yes, on a Sunday morning in early November, my hope and my life stream are both running desperately low, so low, so stagnant, that I hold my breath in fear, believing that the dark, blank curtain is about to descend.
There are millions of men like Morris whose depression is masked by other signs and symptoms. Those who are on the front line of healthcare need to do a better job of recognizing them. Since there is no blood test for depression, we make our diagnoses based on patient response to our questions; but, if we are not asking the right questions, the answers won’t help us prevent future problems.
It is a common assumption that the symptoms of depression are the same for everyone. Now we are learning that symptoms of depression in men may be markedly different from those commonly seen in women.