Fatigue. Feelings of worthlessness. Loss of interest. We recognize these as classic signs of depression.
But according to Terry Real, MSW, LICSW, these symptoms aren’t always the way men experience depression.
So how do we help clients when their depression doesn’t necessarily look like depression?
In this short video, Terry shares a two-pronged approach to help his clients find relief.
Click here for full transcript
Please leave a comment below and tell us how you plan to use this in your work.
As women become more and more independent, they too are expressing depression covertly. However, they are less inclined to act out with physical violence and tend toward verbal abuse and self harm. The layers are definitely there. I believe that both sexes can express covert and overt depressive behaviours thus person-centred approaches to therapy are essential. The covert male depression theory has been demonstrated less so in my practice but I agree that it is a fairly accurate profile described in the video. Dual diagnosis is common.
Yes.. thank you! Let’s move beyond this old gender binary and archetypes.
I agree with this. BUT let us take all of this out of the pathological sphere and call it reactions (plural) rather than disorder or disease.
Yes!
Completely. There are no disorders only imbalances, that show us what needs to be done to rediscover balance
I agree with seeing all of this as reactions to emotional pain and not pathologizing it. I do believe that it’s common for men&women to react differently due to the messages they received growing up and societal influence, plus hormonal differences.
My earliest recollection of depression was third grade. I can see it in my school photo. It was strengthened by an abusive teacher and neglectful, alcohol-cocktail hour-keep-up-with-the-Jones’ focused parents. They could not give me what they did not have themselves.
After IFS therapy for 6 months and working a 12 Step program for Adult Children of Alcoholics (both ongoing) I now understand depression as a conditioned response, and the best protective defense I could muster at 8 years old. “Good job, little me!” And, “what a terrible wounding and loss of life and vitality.”
Depression (covert and overt) became a regular pattern and perhaps remains a risk for me, but as a result of IFS therapy and ACA (ACoA) that risk is more remote than ever. I have recovered my lost self, calmed my inner critic, can grieve my losses and regularly take care and time for my inner child. I have discovered the joy of boundaries, personal agency and locus of control. I have a choice now. The best healing choice I have made is no contact / low contact with my family of origin.
This realization that I have a choice in many areas of my life, does not necessarily guarantee the outcome I
want each time, but it does allow me to experience a sense of genuine self respect and accountability for my life as an adult. It is spiritual and psychological – in the sense that “psyche” is Greek for “soul”.
As I show up for my core wounds with IFS and ACA, I am able to see my life as a gift to discover, explore and learn how to live my deep core values. I know how to take care of my wounded parts, and how to ask for help – which is different from compulsively seeking to be rescued by a therapist, partner, sibling etc. (or substance). I know how to discern the difference between asking for help and asking to be rescued, and what that feels like in my body. I can discern when a therapist, friend or partner is trying to “fix me” rather than simply listening to me with compassion. I am learning to genuinely listen and be present for others. I am SO grateful.
I live more fully, with the capacity to feel all my emotions and feelings, from past trauma as well as current disappointments, and even to trust joy and success might stick around- all of which depression prevents and is intent on shutting down in order to keep me “safe”. This was true back then, when I had no other means or power. Today, in the “now”, I no longer have to use the primitive and highly effective tool of fawning and fainting (playing dead/depression) which is naturally wired, primed or conditioned in my limbic system – in order to just survive. I no longer ask to be rescued or “get my sense of self” from thinking I can rescue others. With ACA and IFS, and the choice of very low / no contact with my foo, I am alive and thriving. I have loving relationships and love my life. 🙂
Thank you for this highly important information for depression in men… the symptoms and behaviors help in understanding overt depression in men..
Men who are abusing, drinking, and in unhealthy and destructive patterns is a useful diagnosis… as a professional addiction, abuse and defense is signs of trauma..
to now realize there is two layers of depression for men the top defended layer and then the depression that is covering up the trauma… helps me to discern and focus on one layer at a time..
Useful
I will keep this in mind as I work with the males assigned to my Anger Control Traing Group.
I immediately thought of two clients that may fit this type of depression masking. One in particular I spotted yesterday, and now have a name for it, because he was being “the perfect client.” Stating, “ I know what I have to do. I’m ready.” All very big, loud, and strong. Sort of, “I got this.” He assessed for no medical need. However, there was a powerful incongruence between his words and his affect that argued for need. The other was a classic clown who got angry and aggressive if we got to close to the festering splinter of his anguish. This helped so much to confirm my gut feeling about these clients and others. I’ve been out of school for less than a year, working on my hours toward my license, so I’m still calibrating my instinct. Thank you for this help.
Depression is, in my experience of life , something of very strong to overcame because you struggle with your feelings hopying to do something better but you can’t find energy enough to do this. I found very interesting the video last time in which was speaking about depression like symptom of post trauma and depression like something that can leads you to have a difficulty in planning daily routine about your projects of the future in general. It’s exactly what i Think because you don’t have a clear idea of what you want to reach in your life .
Seems like a reasonable assumption that they would want to escape depression in the ways described and that they wouldn’t want to admit to depression. Ah but – if I can see it in myself – how to shift the depression in other ways?
If we’re looking at what a human being SEEMS to be in this world – what humans do to/teach each other – all the FEAR (of not being GOOD ENOUGH, being REJECTED) and COMPETITION/COMPARISON – all the disasters in nature – it no wonder a lot of people feel depressed !!! (in my opinion)
We have to look an search A LOT DEEPER ! To ‘what we are ?’ Mind or matter ??
The most IMPORTANT thing in this world must be to find LOVE, in ourselves, and next in our fellow man – without LOVE there is no MEANING ! And love always includes shared interests, not the egotistical way this world is (usually) teaching…
Love and peace – and a happy new year to everyONE
I have just started working with a male client concerning an online affair and this may be the coping mechanism for an underlying depression. My initial approach should then focus on his understanding of online behavior as coping with a deeper issue that has resulted in unacknowledged depression. This video is a good reminder that men are many times going covert in the expression of feelings. Thanks.
I see so much to this, actually also in women, from my experience of a couple of friends, anyway. Most, it brings to mind my father, who turned to drinking in his late 30’s, just about when I left home. It was very much linked to his (as I experienced it, anyway) giving up hope of his being able to make life work out in a good way.
I’ve long known that a sense of helplessness in getting life to work well can link with drinking. I appreciate Terry’s professional expertise. How will I use his assessment? I’m not a clinician. But I share the things I learn both personally and in idea writings.
I am a woman but I identified strongly with the description of covert depression. I self-medicated, was rageful and acted out for years until I found recovery. Frustratingly, the depression and anxiety that I’ve experienced since then is disabling in ways that I didn’t experience while self-medicating. I’ve utilized many mainstream and alternative resources to address these issues but to date, have gotten little relief. Not that I ever want to self-medicate again but it sometimes feels as if I am only half living. I am not hopeless, the journey continues…
Hi Lilliana,
As a woman who has had her own lifetime struggles with anxiety and depression, I can relate. I invite you to check out the recordings of my FB lives Tai Chi infused Thursday’s ,under my Deborah Orman FB page, which combine my life stories and lessons as well as the actual tai chi movements. One of many proven health benefits of tai chi is to help fight depression! The actual movements are helpful in combo with talk; helps move the trauma literally and figuratively out of the body, so to speak. I hope you will join me live sometime at 10 CST USA (: The Tai Chi Health Coach
Hi Deborah would u be able to send a link to movements and talks via email …through a mis diagnosis of a bust appendix for a week …lucky to be alive ….it threw me into hyer thyroid for 3 years which honed the pathway of high anxiety and panic. ..and after a lot of stuff going down recently i have been in it again for 3months totally debilitating. ..and i realized i had not released the body trauma of the thyroid melt down. ..pretty server as i live by myself in the bush …would so appreciate my email. …
sharonejboyd@gmail.com
Great article and interesting, thank you for sharing.
Awareness of depression need to be created,most of them are struggling with depression,
Its really hard to explain about depression,nothing will sound good at state of depression,we have to motivate our self to come out.keep doing this great work Thank you.
Depression is a dangerous disease in today’s world
Coming from the corporate world, this is incredibly important. As we ‘correct’ for culture and productivity we pull folks into this covert stance and it’s honestly a crisis.
This is interesting. I’m in the addiction field, and from what I’ve seen, this applies equally to female depression. Acting out with for, shopping, and men, irritability, drinking, and using drugs is how many women cope when they are depressed. When my clients come into recovery and the distracting behaviors are removed, the depression and anxiety comes to the surface.
Love the interview, a real treat…
Yes, very interesting and recognisable .
It may sound Like a big howl, butb concurrently, there is a reticence for men to admit how steeped it is time consumed. Being in therapy can exert the feeling of being depleted. The person-client can’t recognize and validate that the male of female therapist is here to help and not to discriminate. therapy may stay the same but there is a technical component….and ALL client-therapist isn’t trained to perform. I can see myself undertaking the no sweat taks to understand their struggle…such as workplace stress, functioning or not, and smoky days…but there will always a big gap in how the two genders differ how they work on inthe during therapeutic relationship and this is very adamant to change so soon.
My experience over the past 22 years as a clinician is exactly this – depression in men manifests very differently. In my practice, Men referred for anger management, road rage, temper tantrums in the work place, substance abuse, insomnia and Extreme irritability have ALL responded very well to treatment for depression which included psychotherapy , exercise and medication.
… and not only men…. perhaps better to say, ‘people’
That’s exactly what I wrote. Women just don’t have the major blowups. Their depression manifests in the same way but with constant irritability instead of major aggressive blow ups. A classic example would be the stereotype of the “mad black woman” for a race of women who are depressed and overwhelmed.
It is good that finally someone is talking about the specificity of Covert Depression. I have presented a paper on the subject at the American Art Therapy Association conference in 2015. I use Art Therapy as the 2 level approach. I am sure that you are also aware that medications work differently for males and females to alleviate depression
I can send you the paper if you wish. I did not publish it beyond the presentation at the conference.
I too recognize women and men present differently with depression, and respond differently to treatment. I would appreciate a copy of this paper!
Hi Hannah is there anyway we can have a link to this doc ? Interestingly, you have addressed a difference within the two types that I haven’t heard about. Otherwise Art therapy is a very powerful tool to express the unknown and unexpressed emotions , I wonder if we can apply this to this study in art and how. I am , myself , personally far from being an artist but just a person who is said to be creative. There is a difference , am afraid, in this two motions. Much appreciated !
Hannah, I would be interested in reading your paper. Thanks!
I too would be interested in your paper Hannah
Hi Hannah i would love a copy as well thanks …..Sharon ….sharonejboyd@gmail.com
This was very helpful. I have seen this over and over in the field of addiction and domestic violence. Even though it was in the back of my mind that something else is going on, this video clarified it my mind. Thanks for the insight.
Thanks Ruth and Terry! I very recently had a male client who has Bipolar Disorder and quite a few years ago stopped alcohol and drugs. However, he had a bad accident since then and so for many years has legitimately been on pain pills. He’s been wanting to get off them because he doesn’t like the side-effects. He’s now off the pain pills and realizes that he often did take more then prescribed, such that he was addicted in the same way he was to alcohol and street drugs. When he came to session last week, he was experiencing huge amounts of anxiety and some depression from many life traumas. So now his therapy really begins!
Coming from the corporate world, this is incredibly important. As we ‘correct’ for culture and productivity we pull folks into this covert stance and it’s honestly a crisis.
This matches my experience exactly!!!
Great contribution. Men are great at hiding their depression, sometimes successfully for decades!
The male depression I’ve observed in my family and my fiancé is a bit more subtle even than the pattern being described in this video, in that the man is depressed, but isn’t acting it out in either the “female” mode (over- or under-eating, low energy, etc.) or the “male” one. They’re not drinking, drugging, or womanizing, they’re not rage-aholics, they just think there’s something wrong with them; they can’t get happy, and they have little passion or momentum for their lives. Continuing to get up in the morning and go to work seems more a function of duty, performed because these are “good men” (and they are). Perhaps this level of depression wouldn’t qualify as being chronic enough for treatment, but it’s very real to them, and to me.
It sounds better therapy to be in an isolated place than socializing, for men. It can be an open space and in group, but for individual therapy , cave men looked for pleasure in a safe and comfy secure place. I totally understand this part
I am curious to know if covert depression in men is linked to online reality simulation games such as Second Life? How does one address this when the person feels that it is a harmless form of entertainment, but in reality seems to be a form of escapism and avoidance of intimacy in real life relationships?
Thanks. Really important as not everyone is overtly depressed.
Johnathan, Thank you for your feedback. I would like to know how are their rating in self-esteem and are they judging themselves as outcasts? This is an interesting group…
Excellent interview. I have always suspected that the studies that indicate that women suffer depression at greater rates than men may be questionable. Aboriginal Australian men and women have similar levels of depression because Aboriginal men are culturally allowed to be in touch with their feelings and express them.
Very interesting video, thank you. Terry’s involvement shows something can be done and is to be done …
Are women more prone to depression than men ? I am under the impression it is more difficult for men to recognize that side of the character – for the most. But for other people this is a characteristic that is no different or may be alike and kind of appreciated in certain culture. Am not saying covert or overt behavior here but only how they accept the image of how the are looked upon. Some behaviors are more acceptable to men than to women and vice versa well, accepted .
Great questions! Thanks. I would also use the word “concerned about that you don’t want to admit”, especially if a person is hesitant to admit deep fears, or not even aware of them.
I and two other therapists, one individual and one couple’s therapists, totally missed my husband’s depression. He retired at 62 years old and became an angry “dry drunk” the day he retired. ( At that time he had 17 years of sobriety without a relapse.) He died suddenly on a ski slope doing what he loved three and one half years later of a heart issue. (He never relapsed.)
In retrospect I believe he was depressed and fearful of dying, but could not admit it.
Now I ask male clients, who I suspect are depressed, two questions. What are you afraid of that you are afraid to admit? What do you feel helpless about and don’t want to admit it?
Very helpful questions. Thank you.
My brother Acts the same way by not recognizing the depression and getting help. His panic become intensive and is caused by loss, abandonment by our mother, and now is mortified to the point he is careless about his wife who encourages him to stop smoking, drinking and seeking out rewarding pleasures…I myself can see his falling but it has to come from the man, he is, to get what will be good for him. This comes from my opinion, as a woman.But there is not much to do when this comes from his being raised without a father as a good model. He has no children and doesn’twant any and that makes it hard for the couple. He is letting himself going back to the hole and has no idea this isn’t aaway. I am thankful there is now a focus on men in therapy or who seeks therapy, if not, within the family circle. Thank you for sharing, Lynn.
Very helpful questions. Thank you for sharing them and your story.
In my practice I have found this to be true. Men often present with addictive behaviors and once those are addressed ,the depression comes out. Often men have agitated depressive episodes more than women. Anger is expressed more than sadness. I found this video to be helpful .Thank you both
Linked in what way ??
I’ve heard it is linked to hormonal imbalance (from SOME kind of stress…) – e.g. LOW testosterone and HIGHER ESTROGENE in men ?? THAT makes them emotionally imbalanced ?? (It is not normal for men to be more angry, is it ??? Like it shouldn’t be for women either…) Or… ?
Oh, I’m sorry, this was meant as a reply for Sherry…
tHIS IS my personal observation in my work to see women. bUT my impression is very blurred because it takes more time for a man to confide and for a woman to be comfortably well to say what they really want to say in a session..i have been come to the conclusion there is a projection of their problem to what the reality is. the depression is under covering many difficulties in cultural, gender and age that create Obstacles and barriers to therapeutic rapport
I agree with others that women also will self medicate instead of “owning” their depressive symptoms. Do you find that certain cultures tend to have more covert vs overt depression? Do you think the level of stigma is different within certain cultures?
I agree about how anger is underneath all of the emotions. Sadness that one can be defective and not up to the task of being a human, likely to be perfectly fine, can be a big demand. So the amount of anger that the world outside is putting on a person to be not depressed by what one is going through can be very roughly said, too tough for anyone. Group support that I have helped to facilitate has shown to be a great help to men to open up and to see how others can be empathic rather than rejecting or shameful. Or at least that what has appeared to me sofar
Isn’t it the being depressed in cause and not being a one “or not” one ? a diagnosis such as depression or else like cptsd is just another after another that it is hard to admit to self that one isn’t “good enough? Well, at least there is hope
Wondering if another sign of covert depression is chronic anger. Chronic anger (not speaking of physically violent behavior here) that doesn’t need much provocation to appear seems to be more common and more acceptable among men, probably because it’s percieved to be so closely linked to testosterone.
I think that anger can help pull someone enough out of depression to function somewhat, rather than curl up and not get out of bed. So I see some degree of anger as energizing and helpful, possibly a helpful reframe? I would love to see comments on this!
This sounds like a lack of motivation and looking for some coaching.
I particularly like the coinage of the terms covert and overt depression. In my professional and personal experience, I have seen this in both men and women, equally. I would be curious to know how you would tease out the covert depression vs bipolar 2?
This is a very important observation, however it does not belong just to men and it was a bit of a blunder the way he stated that it is easier and more socially acceptable for women to express depression. It could have been stated more clearly so as not lump all women together and all men together. It’s all a matter of circumstance. There are many, many women who cannot afford to be or show depression. They may be surviving abuse, survival issues around finances or parenting, or have addiction issues, or a variety of other issues.
Tanks for your insight on covert depression and how to treat it before dealing with overt depression,
Jep
Is it about gender?
We’re all humans who like to be treated as humans?
Womanly or unwomanly is avoiding the basic truth that mostly, we all like not to be considered as something unimportant.
First and foremost, I think we need to think a bit more about people?
We might treat others and be treated better when we think of ourselves in the same way we think about US?
Fatuous response perhaps but important, I feel.
Thank you for this.
What I have observed is that this is true about Z’evastrong women do as well.
This was insightful and very helpful, thank you. I had honestly never considered this perspective to understand the behavior of womanizing or self medicating. Facinating and profound. One a side note… Ruth that color on you is absolutely breathtaking. I know it’s off subject but, I felt it worth acknowledging.
Women cry. Men rage. Women are raped and killed. Men make excuses and go numb. How convenient. Women are coming forward to call the whole thing off. It is long overdue that men suffer depression. Let them get ECT and Meds. Women are recovering and evolving. Even in the world of psychology it is the Ogdens, Baders. Poole Hellers, And countless others whose names may not be known who are coming forward. In oneself is the whole world. WE ARE ALl the WORLD. So we have to change. We need RADICAL change. This means ROOT change. We need to stop Thought and meaningless words. We need to be REAL. We need to be WHOLE and end this gender divisiveness, and every other divisiveness. We need humility and accountability. It takes energy and seriousness.
So many lonely women out there it is incredible- the desire and movement of women to be more like men (as popular culture repeatedly states) has really caused a lot of loneliness on both sides I feel- although saying this won’t make you very popular. Men are adjusting also but they are not impressed. Men can take a lot but there are limits. We still do almost all of the dirty dangerous jobs. Depression may well be resulting on both sides from this cultural shift?
Brian—women give birth, which is a pretty hard and still dangerous undertaking. We also are far more likely to be killed by our domestic partners and be underpaid/shut out of higher paying work—including dangerous jobs. Women demanding equality shouldn’t be construed as a threat or burden to men.
It is not true that it is unwomanly to hide depression. The same stigma exists because people see it and want to avoid it for fear of bringing themselves down. I’ve seen it and seem other women talk about it.
The problem is that we have layers that influence layers and getting to the root of something that keeps growing new roots is tricky. People, families, institutioons, countries, and leaderrs all experience this. Thus shark eat shark behaviour.