Dossier: Strong mind

Depression: Men suffer differently

Big boys don’t cry? Likewise, depression in men often goes undetected because their mental anguish manifests itself as aggression, alcoholism or workaholism. How can you identify depression in men?

Text: Stefan Schweiger; photo: iStock

Have you ever been in the situation where you worriedly say to a loved one, friend or colleague: “I’m concerned about you – I see that you’re having a hard time” and they wave you away dismissively? In the case of the six dismissive reactions below, men, and those who’re close to them, should be on high alert.

“Leave me be. All I need is a few drinks down the pub with my mates, then the world will look brighter again.”

Typical male responses include losing themselves in alcohol, work, sport or gaming, explains Dr Andreas Akert. For them, the main thing is that they keep functioning and nobody notices. This isn’t the most effective coping strategy because eventually a breakdown looms. And yet a psychological disorder isn’t a sign of personal failure, but an illness that can be treated effectively – given sufficient understanding.

“I’m not depressed. I’m angry.”

This is often the core of the problem: “In many cases, male depression doesn’t reveal itself primarily in symptoms such as gloominess or lethargy,” says psychotherapist Dr Andreas Walther. “When emotions like anxiety or being overwhelmed don’t find any other outlet, they show up as irritation, aggression, workaholism, wreckless behaviour or increased consumption of alcohol or drugs.”

In other words, defensive mechanisms that are written off as typically male behaviours rather than signs of depression – by the men themselves, by those around them, and even by psychotherapists and psychiatrists. Even though the indications are that men are no less likely to suffer from depression than women. Yes, women fall prone to depression twice as often as men during their lifetime – or, to put it differently, they are diagnosed as such. Men, meanwhile, are three times as likely to commit suicide, which in very many cases is the result of depression.

“Others have much bigger problems than I do.”

Does that mean it’s a question of persisting, keeping going and pushing your feelings to one side? That’s not a good strategy, says Andreas Akert. Our interior life is like a reservoir: when it’s in danger of flooding over, you might want to strengthen the outer walls or make them even higher. But the pressure on the walls just keeps increasing and eventually they cave in.

“If I show weakness, somebody else will immediately take my place.”

Men take on a variety of different roles: father, husband, good bloke, dependable colleague. Most of them manage to perform this balancing act as long as they feel they’ve got things under control and they can suppress any negative emotions. 

But when these negative emotions amplify, they have to fight even harder to retain this sense of control. It’s not masculine to show weakness – at least in the time-honoured view of gender roles. “It’s precisely this feeling of lost control or overpowering sadness that marks out depression,” says Andreas Walther. The stronger this image of masculinity in the man’s mind, the more difficult it is to get through to them successfully with psychotherapy.

“Psychotherapy is for women.”

Studies show that men seek out psychotherapy or psychiatric support around 30 percent less often – and much later – than women. Even though both sexes are thought to be equally prone to depression. Andreas Walther isn’t satisfied with this state of affairs and has put together the elements of a course of psychotherapy at the University of Zurich that's geared specifically to men’s needs, based around cognitive behavioural therapy: “The sooner depression is identified, the easier it is to treat.”

“There’s no point in whining.”

Many men have never learned to talk about feelings and weaknesses, explains Andreas Akert. One of the ways family and friends may be able to help is by opening up about their own weaknesses, fears and negative emotions. Celebrities who have spoken out about their depression are also useful in this regard, as are terms like “burn-out" that men can more easily relate to: after all, only those who are actually on fire can burn out. Pulling yourself together and taking action to regain your mental health is a sign of strength. “It takes courage to seek help!” as Andreas Walther emphasises to his patient. “And it’s an achievement to regain control and be able to pick yourself back up again.” It’s important thereby to take gender and role models into account and talk about them openly. Let’s fight this battle together! That sounds more masculine, right?

The interviewee

Dr Andreas Walther is a psychological psychotherapist and senior researcher in the Department of Clinical Psychology and Psychotherapy at the University of Zurich. Together with his colleagues, he has developed a course of psychotherapy aimed specifically at men.

Dr Andreas Akert is a psychiatrist and chief physician in inpatient services at the Foundation for Holistic Medicine (SGM) clinic in Langenthal. In April 2022, the clinic opened its so-called “Man's Island”, a department dedicated to men who are undergoing a psychological crisis.