The “D” Word – life beyond therapy

Is it a weakness to feel depressed?  What is depression anyway?  Does it show up differently for men than for women?  These are questions I hear a lot of in my private practice.  So many of my male clients talk about depression without really knowing what it is.  In the past couple of years, psychological research is discovering that depression in men often looks really different than it does in women.  This is pretty surprising news.  If it’s true, what does this mean for all you gay, bi and trans men out there?  Let’s talk about the “D” word.

According to Los Angeles Times writer Melissa Healy, “for men, depression is melancholy on steroids…fast driving, heavy drinking, lots of recreational drug use – for all too many men – are symptoms of depression.”  What happens if these symptoms are ignored and not addressed?   In researching her article, Healy found that, for almost 25,000 men a year, the end result of unrecognized depression is suicide.  For many depressed men – regardless of sexual orientation – there is often no cry for help: no river of tears, not even much sadness, just a quiet, tragic ending of a man’s life.  According to Healy, in the United States, a depressed man is four times more likely than a woman to commit suicide, yet he is only half as likely to be diagnosed with depression.  It’s the “D” word indeed:  Don’t ask for help, Don’t tell anyone how lousy you feel, and Don’t get better.

As gay, bi and trans (GBT) men, is this true for us?  According to most of the research I’ve read, depression is more prevalent among GBT men than in heterosexual men.  Historically, oppressed communities (e.g., non-white, non-middle class, non-heterosexual, non-male) have higher rates of depression than straight, white, middle class men.  If so many of us are likely to depressed, what exactly is depression anyway?

Depression in GBT men often looks different than the stereotypic cluster of sadness, guilt and withdrawal that many of us think of when we imagine a depressed person.  Some depressed GBT men suffer symptoms of depression – such as impotence and loss of sexual interest, but others may become wildly promiscuous, complain of sleep troubles, fatigue, headaches or stomach problems – without ever considering that there may be a psychological source to all or some of their symptoms.  Statistically, depressed GBT men are more likely to behave recklessly (e.g., unsafe sex), self-medicate with alcohol and/or drugs, drive too fast and/or seek out emotional confrontation.  All those feelings of depression have to go somewhere!  We turn the unhappiness on ourselves and have internal symptoms or we aim it at other people and fuck with our relationships big-time.

What causes depression?  No one knows for sure.  For all the research that shows that there are genetic markers that run in families, there is equal research that shows it is more environmentally-based.  In my experience, it’s likely a combination of the two.  The success of anti-depressants acknowledges that there is a biological component of depression, yet anti-depressants don’t make you “happy”, they just keep you from feeling super shitty.  They don’t solve your problems and they don’t make life great.  They can take away that totally hopeless feeling that makes you feel like crawling into bed and never coming out…but once you crawl out of bed, then what?  This is where pills don’t help much.  Facing the CAUSE of our depression usually means walking through fire.  Ironically, this is something that we GBT men have been trained to do.  But we’re told we should do it ON OUR OWN.  Is this why we’re so bad at asking for help?  Would John Wayne, James Bond or any of the X-MEN be able to turn to their best friend and say, “Dude, I think I’m depressed”?

Historically, there’s the machismo thing:  depression has long been equated with “weakness”, being a “sissy” and “shame”.  Where I grew up, in rural Ohio, you were supposed to just “grin and bear it” or “pull yourself up by your bootstraps” as my grandpa (the local butcher) told me when I was little.  We may be living in 2009, but the psychological remnants of “boys don’t cry” are still with us.  So instead of admitting we feel like shit, many of us react in the exact OPPOSITE way:  we hide our feelings of depression by acting tough, cool, like we have it all together.  We smile in the clubs, drink way too much and go home with someone cute because we don’t want to wake up alone.  Sound familiar?

How can you tell if you’re “clinically depressed” or just “a little depressed”?  Easy:  does it go away on its own and you feel good about life again?  If so, you’re what I call “normally depressed” by the usual crap that life throws us all.  When you can bounce up in a week or two, you’re not clinically depressed.  But when you feel like shit for three, four, five weeks or more, then you may be “clinically depressed”.  You can’t just “snap out of it”, as Cher told Nicholas Cage in “Moonstruck”.

GBT Latino, African American and Asian Pacific men may suffer the most from cultural taboos against depression.  For example:  a recent survey found that 63% of African Americans considered depression “a personal weakness”.  In his book “Lay My Burden Down”, Harvard Medical School psychiatrist Dr. Alvin Poussaint writes that an epidemic of suicide among young black males is only part of the hopelessness and self-hate among African American men.  These kinds of heavy cultural messages don’t easily go away, and all men suffer – silently – as a result.  So what can we do?

As GBT men, once again, it is up to us to lead our straight brothers out of ignorance and into a new way of being a man.  Many of us, although raised in the same world as our hetero brothers, found that as GBT men, we had to make our own way in the world.  The traditional rules of the world didn’t work for us; we were forced to be pioneers and create our own paths.  Once again, we need to be pioneers and create a new path to mental health.  When we find that we feel shitty for weeks at a time, we need to be man enough to get help.   Depression is debilitating; most of us can’t beat it alone.  This is where our friends, our chosen families, our homeboys come in:  we need to be honest with each other, ask for help and notice when someone we love needs help but may be too embarrassed to ask.  We need to be man enough to admit, “Hell yes, I’m depressed.”

For many of us, the first step in healing our depression is to hear, “I think you’re depressed” from someone close to us.  If you suspect depression in your friend or partner, don’t downplay the changes you see or criticize his behavior.  Instead, tell him that you’re worried about his mood or behavior.  Educate him: let him know him that depression is common in GBT men and doesn’t always feel like sadness.  Let him know that that  “talk therapy” – with or without anti-depressants – brings relief to four out of five men (according to recent research).  Urge your friend/partner to see his doctor and talk with him/her about how he feels.  Many doctors have a short “depression quiz” they give clients to see if depression is just beneath the surface of other more physical symptoms.  You could also talk to a psychotherapist, trusted older friend or minister/rabbi to get a reality check on if you seem depressed or not.

Above all, don’t be afraid to talk about the “D” word:  ask for help, tell someone you trust how lousy you feel and know that you can get better.  We’re all in this together…isn’t this what Brotherhood is really about?
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