When people think about depression they most often think of women as its victims. Indeed, the manual of psychiatric disorders [DSM-IV] states that women's symptoms fit criteria for major depressive disorders 2 to 1 over men. But a new book by Terrence Real takes another look at this formulation. I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression
contends that many men also suffer from depression, but that it takes a more covert form. Real explains that disorders more common among men than women--alcohol abuse, drug dependence, antisocial personality disorder, as well as violent acts such as the battering of women and suicide--may all have depression at their root. Real poses the question, "Why should depression, a disorder of feeling--in psychiatric language, an affective disorder--be handled in the same way by both sexes when most other emotional issues are not?" (p. 23). In fact, Real asserts, men respond in strikingly different ways than women to feelings of despondency and troubling life events.
As Real explores depression in men, he delineates the ways men as children were socialized into "boy culture." During childhood and beyond, boys are often shamed for feelings of vulnerability or desires for intimacy, ways of being that are more readily encouraged for girls and women. To offset this shame, Real describes how boys and men develop coping styles that lean towards narcissism and grandiosity. This allows them to interact with the world and to relate to other people in a manner that preserves their masculine images as powerful, heroic, successful, and invulnerable. The reader is thus led to wrestle with a blurring of our otherwise ordinarily held assumptions of victim and victimizer:
The need to save one's own insecure place in the circle of manhood by participating in oppression, or at the least in remaining silent, while the weak fail is one of the principal dilemmas for boys. . . . Do it to him or he'll do it to you. . . . And the "Sophie's choice" of hammer or nail, victimizer or victim is not relegated to extreme instances. . . . They [boys] learn to betray the humanity in others . . . as a way of protecting themselves, and in so doing they also learn to disconnect from their own compassionate hearts. (p. 174)
We often believe that the victim and the victimizer are two separate beings or, at the very least, two distinct ways of being that do not inhabit a person simultaneously. Given that men are the most significant perpetrators of violence in our society--violence against other men as well as against women--it is a curious notion to think that these men who render such violence against others may themselves be victims of a harsh and unforgiving male culture, leading some men into severe depression.
In understanding these psychological connections between men's inner feelings and outer deeds, while still holding men accountable for their hurtful actions against others, Real offers to readers (as well as to the male patients he sees in clinical practice) a way out of this boyhood bind of "Do it to him or we'll do it to you." By offering compassion to men regarding their shameful feelings, their fears of abandonment, and other hidden fears that they may have tucked in far away places, Real takes a first step in helping men develop a lost compassion for themselves. In turn, this may allow men to fully express that compassion to others. In a society where intense behavioral management, control, and severe punishment are meant to remedy the burgeoning of violent behaviors in young men and little boys, this book inspires us to reconsider that misguided approach. Violence begets violence, while only compassion with accountability can create the possibility of more compassion and open a way for men to talk about what they don't want to talk about--thus beginning the process of healing for all.