From the first day in medical school at Indiana University that we talked about depression, one thing seemed absolutely clear. Women made up the vast majority of those who presented with the symptoms and the diagnosis. The difference in the rate of diagnosis for men and women wasn’t ten or twenty percent. It was 2 to 1 women over men. We had lots of explanations for the phenomena. Women were and still are more likely to see a physician than men for any kind of health problem. Surveys done over the years will vary some, but generally show women seeing doctors from 50 to 100% as often as men.
As a result, for reasons not entirely clear, physicians, psychiatrists, and psychologists of all varieties have
operated with the bias that depression is primarily a problem that women face. And that would be helpful, if
it was true. In research published this week in the online version of the Journal of the American Medical Association, it appears that the reason why men are not diagnosed with depression as often as women is because we in
medicine are simply not asking the right questions.
The research done at the University of Michigan by Lisa A Martin, PhD and others, found that if you ask men the usual DSM4 (Diagnostic Statistical Manual of Mental Disorders) criteria questions that include a sad mood, men will tell you they are not depressed. “Direct admission of sadness and emotional weakness or vulnerability in men is seen as socially unacceptable.” It appears that men want nothing to do with being identified as weak, sad, or vulnerable. [i]
This response appears to be tied to a man’s “adherence or rejection of hegemonic masculinity.”[ii] In English, the more a man agrees with a “John Wayne, Bruce Willis, or Tom Cruise view of manhood the further he will distance himself from anything that looks like sadness or depression. To do great damage to the 1960’s Four Seasons song, “Big Boys* Don’t Cry!”(*Girls in the original) Or, to quote Tom Hanks, “there’s no crying in baseball!”
So, the researchers did what they often do as they search for the answer they believe is “true.” Instead of asking
themselves if they are over diagnosing women, they changed the questions as Jefferson said they would. The researchers used what is called a “Gender Inclusive Depression Scale.” That scale uses questions that identify anger, aggression, and irritability in men as the signs of depression. And, when they were done men had the same rate of depression that women did.
I suppose that we could take this conclusion in several directions. As a physician, I guess I might say that I am not one bit surprised that men and women might suffer sad moods at exactly the same rate. In the book Good Mood Bad Mood, I have reviewed considerable research that tells us that depression as a disease has no easily identified unique pathology (change in our bodies or brains) that would make the diagnosis certain.[iii]
At the same time, research tells us that the DSM4 and now DSM5 criteria are very subjective and are likely to over-diagnose depression as much as 90% of the time. I doubt that changing the criteria to make it more likely that men are diagnosed with depression because they are angry, aggressive or irritable will help them much. Instead of finding
solutions to the anger, aggression, irritability and sadness, we may just be increasing the number of people who will be labeled.
There is something that would help the 90% of men and women who are labeled as depressed because they struggle and suffer due to an identifiable loss in their lives. It would help them to find someone who knows about their loss, who has a plan for that loss, and cares deeply about their struggle and suffering. And, to find out that someone will act on their behalf. I think that would help.
And, there is a great place to look for that something or someone who could help. I would start in John 11. Jesus knew, had a plan, cared deeply and acted to help Martha, Mary and Lazarus. And He will do the same for anyone who comes to Him bringing their anger, aggression, irritability, and sadness over loss. As He said, “Come unto me all you who labor and are heavy laden, and I will give you rest.”(Matthew 11:28-30)
[i] The Experience of
Symptoms of Depression in Men vs Women, Analysis of the National Comorbidity Survey
Lisa A. Martin, PhD1; Harold W. Neighbors, PhD2; Derek M. Griffith, PhD3,4
JAMA Psychiatry. Published online August 28, 2013. doi:10.1001/jamapsychiatry.2013.1985
[iii] Good Mood Bad Mood, Charles Hodges MD, Shepherd Press, 2012, www.shepherdpress.com, Wapwallopen, PA.
See chapters 3-5.